CENTRIFUGAL PUMPS AS LEFT-VENTRICULAR ASSIST FOR CORONARY REVASCULARIZATION ON A BEATING HEART

During recent years, coronary bypass surgery has progressed toward min imizing invasiveness. One important feature of this approach is perfor ming surgery on a beating heart. During the crucial phase of such surg ery, the mechanical support of the heart with a left ventricular assis t device (LVAD) is a possible option. During the period from October 1 , 1994 until June 30, 1997, we employed a centrifugal pump system in 1 18 cases of coronary artery bypass graft (CABG) procedures with LVAD s upport (mechanically supported CABG [SUPPCAB]). A total of 179 distal anastomoses with an average of 1.5 +/- 0.5 coronary anastomoses per pa tient was performed. Three types of pumps were used: 23 BioPump, 87 Is oflow, and 8 Capiox systems. The median time on mechanical support was 44 min (range, 16-116 min). The mean now rate during support time was 3.5 +/- 0.8 L/min, which results in a calculated flow of 1.7 +/- 0.6 L/min/m(2) body surface area (BSA). The average flow was 3.2 +/- 0.8 L /min with the BioPump and 3.7 +/- 0.8 L/min with the Isoflow pump, res pectively (p < 0.01). The mean arterial pressure during mechanical sup port was 75 +/- 12 mm Hg. In 2 patients, the pump system was kept runn ing postoperatively in the ICU. Eight of the patients received operati ons under resuscitation or in cardiogenic shock. Nine (7.9%) of the pa tients did not survive the early postoperative phase. For coronary rev ascularization of the anterolateral and diaphragmatic parts of the hea rt, the SUPPCAB procedure is feasible with excellent mechanical suppor t of the heart by centrifugal pumps. Especially in high risk cases, th is procedure can be recommended.