Intracardiac left ventricular support in beating heart, multi-vessel revascularization.
BACKGROUND
Less invasive operation procedures without support of extracorporeal circulation are becoming increasingly important. A basic requirement for good long-term results in such cases is, however, the complete revascularization of the affected coronary vessels. The unsatisfactorily high conversion rate from bypass operations originally planned as off-pump to conventional operations with heart-lung machines, because of the failure to reach the target vessels on the rear wall of the heart through hemodynamic instability led to investigation of the efficiency of a microaxial pump (Impella elect) placed in the left ventricle.


METHODS
In a prospective project 15 of 38 consecutive patients selected for coronary revascularization with beating heart had a micro pump transaortically implanted in the left ventricle to support the heart during the operation with a flow rate of 2.5 to 3.9 l/min.


RESULTS
With 8 of 23 patients operated on without pump support, the operation had to be converted to conventional methods with a heart-lung machine. Only one patient out of the left-ventricle-supported group had to be further operated on conventionally because of a deep intramyocardial positioned left anterior descending coronary artery (LAD) (p < 0.05). The investigated laboratory parameters, especially creatine kinase (CK), CK-MB isoenzyme, and clotting showed no significant difference. There tended to be a higher blood loss recorded with the pump-supported patients.


CONCLUSIONS
In summary, it appeared that the application of a left ventricular coaxial pump with comparable results seemed to make possible complete revascularization in nearly all patients.
Isgro
Frank
F
Clinic for Cardiac Surgery, Heart Institute Ludwigshafen, Germany.
Kiessling
Arndt H
AH
Rehn
Erik
E
Lang
Johannes
J
Saggau
Werner
W
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006334:Heart Function Tests; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*