Temporary Mechanical Circulatory Support in High-Risk Cardiac Surgery: Contemporary Practice and Insights From U.S. Transplant Centers.

BACKGROUND

To date, evidence regarding the role of temporary mechanical circulatory support (tMCS) for high-risk cardiac surgery (HRCS) is limited and continues to evolve. We aimed to appraise current evidence and characterize contemporary use of tMCS in HRCS across selected U.S. Transplant Centers.

METHODS

The authors have conducted a cross-sectional survey for tMCS use for HRCS. This survey was conducted using the RedCap system evaluating the timing of support, device selection, and technical considerations. The response rate was 74%.

RESULTS

For isolated coronary artery bypass grafting (CABG) patients with left ventricular ejection fraction (LVEF) 25%-35%, no-tMCS and intra-aortic balloon pump were the common approaches. In isolated CABG patients with LVEF less than 25%, more surgeons consider tMCS use including Impella 5.5. For CABG with mitral repair or replacement, more surgeons consider the use of tMCS. The annual volume of Impella 5.5 use for HRCS cases was ≤ 10 cases annually. For arterial access for Impella 5.5, the rate of trans-aortic and trans-axillary approach were equal. For HRCS, the simultaneous approach was more predominant, and most surgeons advance Impella to the left ventricle after the cross-clamp is off. Most surgeons leave Impella 5.5 for 72 h to 1 week. For patients with severe aortic insufficiency, one-fourth of surgeons have performed Impella 5.5 insertion.

CONCLUSIONS

Contemporary practice demonstrates increasing adoption of tMCS use in HRCS with a trend toward preemptive implementation of support. Given limited high-quality evidence and variability in practice, careful patient selection, technical expertise, and institutional experience remain critical to achieving optimal results.