Perioperative temporary mechanical circulatory support with Impella in cardiac surgery patients.

BACKGROUND: The benefits of perioperative mechanical circulatory support (MCS) in cardiac surgery patients are still uncertain. This study aims to review early outcomes of perioperative temporary MCS using the Impella device in cardiac surgery patients. METHODS: Retrospective, single-center analysis in cardiac surgery patients presenting with cardiogenic shock (CS) in whom Impella was used for perioperative temporary MCS, either as single device therapy or as left ventricular (LV) venting strategy for concomitant extracorporeal membrane oxygenation (ECPELLA). Study outcomes were 30-day mortality and occurrence of complication composite outcome. RESULTS: Between 2016 and 2019, a total of 33 consecutive patients were supported with Impella (single-device therapy in 19 [57.6%] patients and ECPELLA in 14 [42.4%] patients). The 30-day mortality of Impella-alone and ECPELLA groups was 15.8% and 50.0% (P=0.03). The 30-day mortality according to pre-, intra-, and postoperative implantation was 12.5%, 60.0%, and 28.6% (P=0.04), and it was significantly lower in those patients in whom a left ventricular assist device was implanted in comparison to all other surgical procedures (P<0.01). The complication composite outcome occurred more frequently after axillary implantation compared to femoral Impella (P=0.05) due to higher stroke rates (P=0.03). Bleeding requiring surgical re-exploration was more frequent in the ECPELLA than in the Impella-alone group (1 [3.0%] vs. 5 [15.1%]; P=0.03). CONCLUSIONS: Temporary MCS with Impella is associated with high complication and mortality rates. However, preoperative use of Impella as single-device temporary MCS is associated with lower mortality rates and is a reasonable alternative as a bridge-to-decision strategy for acutely decompensated patients.

Trans-apical beating-heart implantation of neo-chordae to mitral valve leaflets: results of an acute animal study.

OBJECTIVE: Trans-apical beating-heart implantation of neo-chordae is yet an experimental procedure for mitral valve (MV) repair. We aimed to assess the performance of a new device in an acute animal study. METHODS: A total of four domestic adolescent pigs were used as an acute model. The MV was assessed on the beating heart through a conventional trans-apical access. The NeoChord DS1000 device was used to implant polytetrafluoroethylene (PTFE) sutures to the MV leaflets. Procedural performance of the device was assessed and completed with surgical workflow analysis. RESULTS: Overall 57 implantations using epicardial echocardiography guidance were performed (mean 14.3 implantations per animal). The MV leaflets were successfully grasped every second attempt (mean 2.3±1.9) with no difference between the anterior and the posterior leaflet. A significant difference between an 'expert' surgeon (n>20 implantations) and beginner surgeon was detected with regard to the duration for successful leaflet grasping (65±73 vs 127±105 s; p=0.02) and the overall duration for implantation (130±86 vs 230±119 s; p=0.002). Gross anatomy did not show major tear of leaflets. There were no device-related technical problems. CONCLUSION: The NeoChord DS1000 device for trans-apical beating-heart implantation of neo-chordae to the MV valve showed a high procedural success. A significant difference between an expert and beginner surgeon was detected, which emphasizes the importance of training before introduction of this new technique into clinical practice. Surgical workflow analysis proved to be a valuable tool to assess the performance of this new technique.