A potential survival benefit in coronary artery bypass grafting with micro-axial temporary pump recovery in patients with reduced left ventricular ejection fraction.

Abstract

Coronary artery bypass grafting (CABG) with temporary micro-axial ventricular assist device (Impella, Johnson and Johnson, Danvers, MA, USA) for peri-operative recovery has been utilized among patients with reduced left ventricular ejection fraction (LVEF). We hypothesized that Impella recovery CABG would be associated with increased two-year survival, compared to traditional intra-aortic balloon pump (IABP) recovery CABG. 151 patients with low LVEF (≤ 25%) underwent on-pump CABG at our hospital system between July 2017 and March 2025. Patients who underwent CABG without mechanical assistance, had a cardiac arrest within 24 hours of CABG, prior organ transplantation, or chronic dialysis were excluded. Propensity score analysis matched patients with Impella recovery (n = 19) and IABP recovery CABG (n = 19), and Kaplan-Meier analysis compared two-year survival between these groups. Patients who received Impella recovery CABG had significantly greater two-year survival at 100% compared to the IABP group at 60.5% (95% CI 39.9-91.7%) (log-rank p = 0.01). Impella recovery was associated with greater aortic cross clamp (p = 0.02) and cardiopulmonary bypass (p < 0.001) times and longer ICU stays (p = 0.008). There were no significant differences in major postoperative complications, including re-exploration for bleeding, stroke, and renal failure. Our exploratory study found that Impella recovery CABG was associated with decreased mortality compared to IABP recovery among patients with reduced LVEF. Larger cohorts with longer follow-up are necessary to assess whether this advanced mechanical support method confers a meaningful survival benefit in this high-risk patient population.