Cabrucci Francesco, Baudo Massimo, Yamashita Yoshiyuki, Yakobitis Amanda, Murray Courtney, Torregrossa Gianluca
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA.
Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA 19096, USA.
Biomedicines. 2025 May 21;13(5):1259. doi: 10.3390/biomedicines13051259.
Choosing the best surgical approach for coronary revascularization in patients with ischemic cardiomyopathy and low EF is complex. Several strategies have been adopted, including on- and off-pump CABG, the use of IABP, and the combination of ECMO or even LVAD with CABG. Recently, the Impella 5.5 micro-axial pump has been used as perioperative temporary left ventricular support in CABG patients. This study aims to report a series of CABG procedures performed with Impella assistance, highlighting its potential benefits in high-risk surgery cases. Between January 2023 and December 2024, seven consecutive patients underwent on-pump beating CABG with planned central Impella 5.5 support via a 10 mm graft in the ascending aorta. This study focused on assessing perioperative outcomes in patients with reduced ventricular dysfunction (ejection fraction [EF] < 35%) undergoing CABG with Impella-assisted support. Seven patients were included in the study, with a median age of 70 [IQR 57-74.7], and six were male. Hypertension was present in all patients, diabetes in six, and COPD in two, and two were in dialysis. The median preoperative EF was 20% [IQR, 18-29%], and the median STS PROM was 5.5 [IQR: 2.9-8.9]. One patient had preoperative IABP support. Four patients required intraoperative transfusions, but all remained hemodynamically stable upon OR exit. The Impella was removed after an average of 5.6 ± 2.1 days. One patient underwent surgical revision for bleeding. No strokes, myocardial infarctions, repeat revascularizations, or mortality occurred postoperatively. The median postoperative hospital stay was 21 [IQR, 17.5-22] days, with a discharge EF of 38% [IQR 33.5-38%]. One patient died 6 months after the procedure due to sepsis caused by a gangrenous diabetic leg. This initial experience using Impella 5.5 support in CABG patients with reduced EF demonstrated its feasibility in selected cases. The Impella provided effective circulatory support, ensuring stable hemodynamics throughout the postoperative stay without complications.
为射血分数（EF）较低的缺血性心肌病患者选择最佳的冠状动脉血运重建手术方法是复杂的。已经采用了多种策略，包括不停跳冠状动脉旁路移植术（CABG）、使用主动脉内球囊反搏（IABP），以及体外膜肺氧合（ECMO）甚至左心室辅助装置（LVAD）与CABG联合使用。最近，Impella 5.5微轴泵已被用作CABG患者围手术期的临时左心室支持。本研究旨在报告一系列在Impella辅助下进行的CABG手术，突出其在高风险手术病例中的潜在益处。在2023年1月至2024年12月期间，连续7例患者接受了不停跳CABG手术，并计划通过升主动脉10毫米移植物进行中心Impella 5.5支持。本研究重点评估了在Impella辅助支持下接受CABG手术的心室功能减退（射血分数[EF]<35%）患者的围手术期结局。7例患者纳入研究，中位年龄为70岁[四分位间距57 - 74.7]，6例为男性。所有患者均患有高血压，6例患有糖尿病，2例患有慢性阻塞性肺疾病（COPD），2例正在接受透析。术前中位EF为20%[四分位间距，18 - 29%]，中位胸外科医师协会（STS）预计风险（PROM）为5.5[四分位间距：2.9 - 8.9]。1例患者术前接受IABP支持。4例患者术中需要输血，但所有患者在离开手术室时血流动力学均保持稳定。Impella平均在5.6±2.1天后移除。1例患者因出血接受了手术修复。术后未发生中风、心肌梗死、再次血运重建或死亡。术后中位住院时间为21天[四分位间距，17.5 - 22]，出院时EF为38%[四分位间距33.5 - 38%]。1例患者在术后6个月因坏疽性糖尿病足引起的败血症死亡。在EF降低的CABG患者中使用Impella 5.5支持的这一初步经验证明了其在特定病例中的可行性。Impella提供了有效的循环支持，确保术后整个住院期间血流动力学稳定且无并发症。
