Background: The Impella left ventricular assist device is an effective tool for the treatment of cardiogenic shock. Supporting surgical patients with low left ventricular ejection fraction (LVEF) with Impella in the pre- and postoperative periods can improve the results and prevent the shock.
Hypothesis: Recent studies report the benefits of unloading the left ventricle before coronary reperfusion in the acute setting. We believe that the benefits can be extended to chronic ischaemic patients.
Methods: Between 2018 and 2019, 10 patients underwent cardiac surgery assisted by Impella 5.0. Five underwent off-pump coronary artery bypass grafting (OPCABG), two had OPCABG and mitral valve (MV) repair, one had aortic valve replacement (AVR) and MV repair, one had OPCABG and AVR, and one had left ventricular aneurysmectomy and MV replacement. The Impella 5.0 was surgically positioned, via side conduit, through to either the left femoral artery (n=8) or right axillary artery (n=2), 24 hours before the operation. The mean age was 63 ± 7 years. The mean baseline LVEF was 27.5% (20%–32%) and the duration of Impella support was 8 days (4–12 days).
Results: Haemodynamics improved immediately after the positioning of mechanical support. The operations were conducted in the usual manner. A low dose of inotropes was used in all patients in the postoperative time. Mortality occurred in three patients (33%).
In one case, this was due to multi-organ failure (MOF; an OPCABG patient), and in the other two cases the cause was intracranial bleeding (both in extracorporeal circulation patients). The device was weaned in all except the MOF patient, with optimal haemodynamics and no inotropes. The remaining seven patients had no major complications and were discharged into medical therapy at a mean of 21 days.
Conclusion: Impella preconditioning before surgery and as support in the postoperative period is feasible and effective, allows us to operate on low EF patients using low-dose inotropes and helps to avoid postcardiotomy cardiogenic shock. In OPCABG, it allows easier positioning and emptying of the heart. However, the two cases of intracranial bleeding remain to be explained, despite being successfully weaned from the support.