Coronary Artery Bypass Grafting on Microaxial Flow Pump Support in Patients With Severely Reduced Left Ventricular Ejection Fraction

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2025-06-04 DOI:10.1111/aor.15038

Gaik Nersesian, Daniel Lewin, Yuriy Hrytsyna, Pia Lanmueller, Sascha Ott, Nicolas Merke, Volkmar Falk, Felix Schoenrath, Evgenij Potapov, Alaa Abd El Al

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Abstract

Introduction

Patients with coronary artery disease (CAD) and severely reduced left ventricular ejection fraction (LVEF) face high perioperative risks during surgical revascularization. This case series examines outcomes in CAD patients with LVEF ≤ 25% undergoing surgical revascularization on microaxial flow pump (mAFP) support.

Methods

We retrospectively analyzed 12 patients at Deutsches Herzzentrum der Charité who underwent scheduled protected coronary artery bypass grafting (CABG) with full-flow mAFP support. Patients with acute myocardial infarction or no myocardial viability were excluded.

Results

The cohort had a median age of 60 years [59; 66], 92% male, BMI 26 ± 6.2 kg/m², median LVEF 18% [15; 24], and LVEDD 69 mm [59; 78]. Seven patients had diabetes mellitus and chronic renal failure, and five had prior myocardial infarctions. The mean EUROSCORE II was 2.5 ± 0.6.

Surgical revascularization was performed with ongoing mAFP support, with a median of 3 distal anastomoses. Complete revascularization was achieved in 11 cases and surgical time was 254 min [187; 266]. Myocardial recovery occurred in seven patients, while four required durable left ventricular assist device implantation, and one died on mAFP support. Two (16.6%) patients died during a follow-up period of 93 days. Median Impella support lasted 6 days [3; 9], invasive ventilation 13 h [11; 20], and ICU stays 4.5 days [4; 17].

Complications included one bleeding requiring revision, two mAFP exchanges due to thrombosis/dislodgement, and four thromboembolic strokes in three patients during mAFP explantation/exchange.

Conclusion

Revascularization with mAFP support is a feasible approach for high-risk CAD patients but is associated with support-related complications, including thromboembolic strokes during mAFP manipulations (e.g., explantation or exchange). Prospective randomized trials are essential to evaluate the potential benefits of intraoperative mAFP support during surgical revascularization compared to alternative mechanical support strategies and/or pharmacological measures.

Abstract Image

查看原文本刊更多论文

微轴流泵支持冠状动脉旁路移植术治疗左室射血分数严重降低的患者。

导论：冠心病（CAD）和左心室射血分数（LVEF）严重降低的患者在手术血运重建术中面临着很高的围手术期风险。本病例系列研究了LVEF≤25%的CAD患者在微轴流泵（mAFP）支持下进行外科血运重建的结果。方法：我们回顾性分析了12例在德国慈善医院接受全流量mAFP支持的保护性冠状动脉旁路移植术（CABG）患者。排除急性心肌梗死或无心肌活力的患者。结果：该队列的中位年龄为60岁[59；66]，男性92%，BMI 26±6.2 kg/m2，中位LVEF 18% [15；LVEDD为69 mm [59；78]。7例患者合并糖尿病和慢性肾功能衰竭，5例既往有心肌梗死。平均EUROSCORE II为2.5±0.6。外科血管重建术是在持续的mAFP支持下进行的，中间有3个远端吻合口。11例患者实现了完全血运重建，手术时间为254分钟[187；266]。7例患者心肌恢复，4例患者需要持久的左心室辅助装置植入，1例患者死于mAFP支持。2例（16.6%）患者在93天随访期间死亡。中位Impella支持持续6天[3]；9]、有创通气13 h [11；20]， ICU住院4.5天[4；17)。并发症包括1例需要翻修的出血，2例由于血栓形成/移位的mAFP置换，3例患者在mAFP移植/置换期间发生4例血栓栓塞性中风。结论：mAFP支持下的血运重建术是高危CAD患者的可行方法，但与支持相关的并发症有关，包括mAFP操作（例如，移植或置换）期间的血栓栓塞性中风。与其他机械支持策略和/或药物措施相比，前瞻性随机试验对于评估手术血运重建术中mAFP支持的潜在益处至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.