Use of an Axillary-Implanted Transaortic Microaxial Left Ventricular Assist Device for Elective High-Risk OPCAB: Technique Description and Initial Experience

Background: The use of percutaneous micro-axial pump in high-risk percutaneous coronary intervention (PCI) patients is an established strategy in patients with severe left ventricular dysfunction. The use of an axillary-implanted microaxial pump and off-pump coronary artery bypass grafting (OPCAB) is a new option in treatment of a high-risk patient group with ischemic cardiomyopathy (isch. CMP). We here present our technique and initial clinical experience.

Method: Between August 2020 and August 2021, a total number of six patients (mean age: 68.3 ± 4.2, 100% male) underwent axillary implanted microaxial pump implantation using the right axillary artery and OPCAB surgery for multivessel coronary artery disease (CAD) and isch. CMP. We describe the technique and peri-, early, and midterm postoperative outcomes of this novel strategy.

Results: All patients had a severe isch. CMP with multivessel CAD. Mean ejection fraction preoperative was assessed by TEE (25.6 ± 4.7%) and MRI (23 ± 4.2%, LVEDV mean: 294.0 ± 103.3 mL). ProBNP was increased (mean: 5,559.5 ± 4,515 ng/L). The target vessels were planned preoperatively by the heart team.

Implantation of the axillary pump (Impella 5.0, Abiomed) was successful in all patients, in four patients with TEE guidance only. There was no conversion to heart–lung machine. Complete revascularization as preplanned was achieved in all patients with complete arterial revascularization in five patients (83.3%) and a total of 2.5 ± 0.5 anastomoses. Mean operation time was 313.3 ± 17.5 minutes.

Mean ventilation time was 16.3 ± 10.1 hours, all patients have been mobilized on ward during support with Impella 5.0. The first two patients had a re-thoracotomy for bleeding using the manufacturer recommended heparin purge dosage. Thereafter, we used a lower heparin dosage, and these four patients did not experience any adverse events. Total support time has been 3.8 ± 2.3 days. All microaxial pumps have been removed without complications using local anesthesia. Mean duration on ICU was 5.2 ± 2.1 days and hospital stay 11.6 ± 3.4 days. In hospital and mid-term survival (up to 1 year) is 100%.

Conclusion: Protected OPCAB using axillary implanted microaxial pump support in elective patients with isch. CMP is feasible and safe. Complete revascularization is achievable under these conditions. Postoperative support by means of Impella and uncomplicated mobilization is a great advantage for the patients.

Publication History

Article published online:
03 February 2022