First Turkish Experiences of Assisted Beating-Heart Coronary Artery Bypass Graft with the Impella Microaxial Ventricular Assist Device®


  • Cenk Eray Yildiz
  • Murat Sayin
  • Halit Yerebakan
  • Suha Kucukaksu



The importance of minimally invasive cardiac operations, performed off-pump, without the support of cardiopulmonary bypass (CPB), is continuously increasing. Complete revascularization of obstructed coronary arteries is needed to obtain a better long-term outcome. Insertion into the left ventricle of an efficient microaxial pump can be useful when targeting an important coronary artery located at posterior wall of the heart in a patient with hemodynamic deficiency. The use of such a device can enable surgeons to avoid conversion from a preplanned off-pump strategy to traditional on-pump coronary bypass surgery. The Impella Microaxial Ventricular Assist Device® (VAD) (Abiomed, Aachen, Germany) is a miniature pump with a 7-mm catheter and a flow rate of approximately 2.5-5 L/min. This device can enable cardiovascular surgery to be performed without damaging the left ventricle and causing serious aortic deficiency. Therefore, in patients with serious comorbidity, complete revascularization may be performed off pump, with the heart beating, because of the hemodynamic stability provided with the support of the microaxial intracardiac pump. If required, this pump can also support the heart during the early postoperative period. We report the first assisted beating-heart coronary artery bypass graft surgery performed with the Impella Microaxial VAD in our country. The surgery was performed on 2 patients considered high risk on the basis of EUROSCORE® testing.


Arom KV, Emery RW, Flavin TF, Peterson RJ. 1999. Cost-effectiveness of minimally invasive coronary artery bypass surgery. Ann Thorac Surg 68:1562-6.nAutschbach R, Rauch T, Engel M, et al. 2001. A new intracardiac microaxial pump: first results of a multicenter study. Artif Organs 25:327-30.nBoyd WD, Desai ND, Del Rizzo DF, Novick RJ, McKenzie FN, Menkis AH. 1999. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg 68:1490-3.nCalafiore AM, Teodori G, Di Giammarco G, et al. 1997. Minimally invasive coronary artery bypass grafting on a beating heart. Ann Thorac Surg 63:S72-5.nCartier R, Brann S, Dagenais F, Martineau R, Couturier A. 2000. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. J Thorac Cardiovasc Surg 119:221-9.nCleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. 2001. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 72:1282-8.nDekker AL, Geskes GG, Cramers AA, et al. 2001. Right ventricular support for off-pump coronary artery bypass grafting studied with biventricular pressure—volume loops in sheep. Eur J Cardiothorac Surg 19:179-84.nGründeman PF, Borst C, Verlaan CW, Meijburg H, Mouës CM, Jansen EW. 1999. Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass. J Thorac Cardiovasc Surg 118:316-23.nGundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. 1998. Seven-year follow-up of coronary artery bypass performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:1273-7.nIsgro F, Kiessling AH, Mittelstaedt H, Saggau W. 2001. Surface modification of extracorporeal circuits: is there really an impact on cerebral performance after cardiopulmonary bypass? Thorac Cardiovasc Surg 49:65-9.nIsgro F, Kiessling AH, Rehn E, Lang J, Saggau W. 2003. Intracardiac left ventricular support in beating heart, multi-vessel revascularization. J Card Surg 18:240-4.nKirklin JK. 1991. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass. Ann Thorac Surg 51:529-31.nMeyns B, Sergeant P, Nishida T, Perek B, Zietkiewicz M, Flameng W. 2000. Micropumps to support the heart during CABG. Eur J Cardiothorac Surg 17:169-74.n



How to Cite

Yildiz, C. E., Sayin, M., Yerebakan, H., & Kucukaksu, S. (2010). First Turkish Experiences of Assisted Beating-Heart Coronary Artery Bypass Graft with the Impella Microaxial Ventricular Assist Device®. The Heart Surgery Forum, 13(1), E60-E62.