Impella 5.0/5.5-Assisted Off-Pump Coronary Artery Bypass Surgery in Patients with Severely Impaired Left Ventricular Function: A Single-Center Descriptive Feasibility and Safety Study

Abstract

Patients with severely impaired left ventricular ejection fraction (LVEF) undergoing surgical coronary revascularization face elevated perioperative risk. We retrospectively analyzed all consecutive patients who underwent off-pump coronary artery bypass (OPCAB) surgery under prophylactic Impella 5.0/5.5 support at a single center between 2020 and 2023. The primary endpoint was 30-day all-cause mortality; secondary endpoints were the change in LVEF to discharge, early graft patency on computed tomography angiography, duration of support, and device- and access-related complications. Twenty-one patients were included. Median age was 63 years (IQR 59–74), 19 (90.5%) were male, and median EuroSCORE II was 10.8% (IQR 7.8–17.8). Median preoperative LVEF was 20% (IQR 20–28). Complete revascularization was achieved in all patients, and none required intraoperative conversion to cardiopulmonary bypass. Median duration of Impella support was 4 days (IQR 2–7). Median LVEF at discharge was 38% (IQR 34–40), with a median within-patient change of +16 percentage points (IQR 10–20). Predischarge computed tomography angiography showed early graft failure in one patient (4.8%). Two patients (9.5%) required postoperative escalation to veno-arterial extracorporeal membrane oxygenation, and 30-day mortality was 4.8% (n = 1). Impella 5.0/5.5-assisted OPCAB appears feasible in selected patients, with a complication profile that warrants further evaluation given the low number of patients enrolled. This uncontrolled series cannot establish a benefit attributable to Impella; prospective controlled evaluation is required.