Epicardial echocardiography for correct placement of the intracardial biventricular assist device (Impella).
BACKGROUND
Correct placement of the intracardial biventricular assist device (Impella) as a supporting system for off-pump coronary surgery is routinely checked by transesophageal echocardiography and invasive pressure measurements. However, it remains difficult to verify the accurate position of the right heart system when the posterior wall is exposed.


METHODS
In 23 patients undergoing augmented beating heart CABG surgery, the correct placement of the lmpella-system was controlled by TEE as well as by a new 15-6 L epicardial echotransducer (EE) (Agilent, Andover, MA).


RESULTS
TEE assisted well in inserting the system in all patients. The correct placement of the distal end of the right heart system 1.5 cm behind the pulmonary valve was verified in 18/23 cases by TEE vs. 23/23 cases by EE. Dislocation of the devices during tilting of the heart could only be verified by EE.


CONCLUSIONS
Epicardial echocardiography is a useful, innovative method for monitoring the correct placement of the new intracardial biventricular assist device during beating-heart surgery.
Ender
J
J
Abteilung für Anästhesiologie und Intensivmedizin II, Leipzig, Germany. ender.cakai@parkkrankenhaus-leipzig.de
Anwar
N
N
Brose
S
S
Engel
M
M
Retry
A
A
Autschbach
R
R
D001026:Coronary Artery Bypass / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000295:instrumentation* / Q000379:methods; D017548:Echocardiography, Transesophageal; D006353:Heart-Assist Devices / Q000592:standards; D006801:Humans; D016343:Monitoring, Intraoperative