Osswald Anja, Shehada Sharaf-Eldin, Zubarevich Alina, Kamler Markus, Thielmann Matthias, Sommer Wiebke, Weymann Alexander, Ruhparwar Arjang, El Gabry Mohamed, Schmack Bastian
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Front Cardiovasc Med. 2023 Jul 11;10:1229336. doi: 10.3389/fcvm.2023.1229336. eCollection 2023.
Surgical treatment of patients with mitral valve regurgitation and advanced heart failure remains challenging. In order to avoid peri-operative low cardiac output, Impella 5.0 or 5.5 (5.x), implanted electively in a one-stage procedure, may serve as a peri-operative short-term mechanical circulatory support system (st-MCS) in patients undergoing mitral valve surgery.
Between July 2017 and April 2022, 11 consecutive patients underwent high-risk mitral valve surgery for mitral regurgitation supported with an Impella 5.x system (Abiomed, Inc. Danvers, MA). All patients were discussed in the heart team and were either not eligible for transcatheter edge-to-edge repair (TEER) or surgery was considered favorable. In all cases, the indication for Impella 5.x implantation was made during the preoperative planning phase.
The mean age at the time of surgery was 61.6 ± 7.7 years. All patients presented with mitral regurgitation due to either ischemic ( = 5) or dilatative ( = 6) cardiomyopathy with a mean ejection fraction of 21 ± 4% (EuroScore II 6.1 ± 2.5). Uneventful mitral valve repair ( = 8) or replacement ( = 3) was performed via median sternotomy ( = 8) or right lateral mini thoracotomy ( = 3). In six patients, concomitant procedures, either tricuspid valve repair, aortic valve replacement or CABG were necessary. The mean duration on Impella support was 8 ± 5 days. All, but one patient, were successfully weaned from st-MCS, with no Impella-related complications. 30-day survival was 90.9%.
Protected cardiac surgery with st-MCS using the Impella 5.x is safe and feasible when applied in high-risk mitral valve surgery without st-MCS-related complications, resulting in excellent outcomes. This strategy might offer an alternative and comprehensive approach for the treatment of patients with mitral regurgitation in advanced heart failure, deemed ineligible for TEER or with need of concomitant surgery.
二尖瓣反流合并晚期心力衰竭患者的外科治疗仍然具有挑战性。为避免围手术期低心排血量，择期在一期手术中植入的Impella 5.0或5.5（5.x）可作为二尖瓣手术患者的围手术期短期机械循环支持系统（st-MCS）。
2017年7月至2022年4月期间，11例连续患者接受了高危二尖瓣反流手术，并使用Impella 5.x系统（Abiomed公司，马萨诸塞州丹弗斯）进行支持。所有患者均在心脏团队中进行了讨论，要么不符合经导管缘对缘修复（TEER）的条件，要么认为手术是有利的。在所有病例中，Impella 5.x植入的指征是在术前规划阶段确定的。
手术时的平均年龄为61.6±7.7岁。所有患者均因缺血性（n=5）或扩张性（n=6）心肌病出现二尖瓣反流，平均射血分数为21±4%（欧洲心脏手术风险评估系统II 6.1±2.5）。通过正中胸骨切开术（n=8）或右外侧小切口开胸术（n=3）顺利完成二尖瓣修复（n=8）或置换（n=3）。6例患者需要同时进行三尖瓣修复、主动脉瓣置换或冠状动脉旁路移植术等相关手术。Impella支持的平均持续时间为8±5天。除1例患者外，所有患者均成功撤离st-MCS，且无与Impella相关的并发症。30天生存率为90.9%。
在高危二尖瓣手术中应用Impella 5.x进行受保护的心脏手术并使用st-MCS是安全可行的，且无st-MCS相关并发症，结果良好。该策略可能为晚期心力衰竭二尖瓣反流患者提供一种替代且全面的治疗方法，这些患者被认为不符合TEER条件或需要同时进行手术。
