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. 2020 Jan;35(1):113-117.
doi: 10.1111/jocs.14367. Epub 2019 Dec 3.

The postoperative use of Impella as a ventricular assist device in high-risk patients undergoing coronary artery bypass surgery: A case series and comparison

Michel J Sabra  1 , Weston G Andrews  1 , Marie L Crandall  1 , John P Pirris  1   2
Affiliations

The postoperative use of Impella as a ventricular assist device in high-risk patients undergoing coronary artery bypass surgery: A case series and comparison

Michel J Sabra et al. J Card Surg. 2020 Jan.

Abstract

Introduction: Prophylactic placement of intra-aortic balloon pumps (IABPs) for hemodynamic support has been used in high-risk patients undergoing coronary artery bypass grafting (CABG) surgery. The use of the Impella CP (ICP) heart pump in high-risk patients undergoing CABG has not been reported. In this study, we report our experience using ICP and IABP devices in high-risk patients during the postoperative period.

Methods: This is a case series and retrospective comparison of ICP vs IABP at a single institution using data from 2017. Twenty-eight patients underwent postoperative placement of either the ICP or an IABP. Nineteen patients received IABP and nine received the ICP heart pump. Patient characteristics, comorbidities, and complications were compared using bivariate analysis. Exact logistic regression was used to compare risk-adjusted mortality.

Results: There were no statistically significant differences in epidemiologic characteristics, risk factors, or outcomes between both groups, except the ICP group had a lower preoperative left ventricular ejection fraction (22.5 vs 35; P = .028). Exact logistic regression analysis did not show a difference in 30-day mortality between both groups (P = .086).

Conclusion: The postoperative use of the ICP heart pump, to support high-risk patients undergoing CABG, is a safe option. This practice has allowed us to perform CABG on sicker patients, specifically with depressed ejection fractions, with comparable results to the IABP. Further studies with larger patient populations are needed to draw definitive conclusions, but this pilot study demonstrates a possible expanded use of the Impella device.

Keywords: Impella; coronary artery bypass; high-risk; intra-aortic balloon pump.

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References

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