Sumii Keisuke, Hamaguchi Hiroe, Goto Koichiro
Anesthesiology, Saitama Sekishinkai Hospital, Sayama, JPN.
Cureus. 2025 Jun 4;17(6):e85315. doi: 10.7759/cureus.85315. eCollection 2025 Jun.
Perioperative cardiogenic shock can be fatal, and assisted circulation with an Impella percutaneous ventricular support pump catheter (Abiomed, Danvers, MA, USA) is useful in patients with severely compromised cardiac function. However, we report a case in which an Impella implanted preoperatively deepened its position during off-pump coronary artery bypass grafting decannulation. This change in position caused the Impella to interfere with the posterior mitral valve leaflet and led to severe mitral regurgitation and difficulty with intraoperative circulatory control. In patients without significant left ventricular enlargement, the heart team should discuss the risk of interference with the mitral valve and inhalation failure during decannulation. In such cases, other forms of assisted circulation, such as intra-aortic balloon pumping or cardiopulmonary bypass, should be considered.
围手术期心源性休克可能是致命的，使用Impella经皮心室辅助泵导管（美国马萨诸塞州丹弗斯市Abiomed公司生产）进行辅助循环对心功能严重受损的患者很有用。然而，我们报告了一例术前植入的Impella在非体外循环冠状动脉旁路移植术拔管期间位置加深的病例。这种位置变化导致Impella干扰二尖瓣后叶，进而导致严重二尖瓣反流和术中循环控制困难。对于左心室无明显增大的患者，心脏团队应讨论拔管期间干扰二尖瓣和吸入失败的风险。在这种情况下，应考虑其他形式的辅助循环，如主动脉内球囊反搏或体外循环。
