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Mechanical cardiac support and abdominal vascular surgery

Department of Thoracic, Cardiac, and Vascular Surgery, University Göttingen, Göttingen 37075, Germany

Abdominal aortic aneurysm surgery with mechanical support using the Impella^® microaxial blood pump

Congratulations to Dr. Farhat and colleagues [1] for this excellent idea to perform surgery of abdominal aortic aneurysm (AAA) with mechanical left ventricular support using the Impella microaxial blood pump in a patient with ischemic heart failure and low ejection fraction.

Implantation of endovascular prosthesis could be the only alternative treatment in this complicated case. Maybe a new endovascular stent graft device with a short proximal landing zone could have been used. Also, suprarenal stent-graft fixations for infrarenal AAA have been reported with good short- and mid-term results [2]. Implantations of fenestrated stent-grafts for infrarenal AAA with infrarenal anatomy unsuitable for a standard graft have been performed with a low complication rate [3]. Long-term follow-up data are, of course, still required.

The presented modified implantation technique of the Impella microaxial blood pump via right subclavian artery through a dacron tube is smart. Although placement of the microaxial pump into the ventricle under fluoroscopy is the standard procedure, I would suggest additionally intraoperative transoesophageal echocardiography (TEE) for control of device position in left ventricle and continuous observation of ventricular contractility and volume filling during surgery.

The greatest advantage of the device is its easy handling – the fact that this microaxial pump does not require full systemic anticoagulation. Disadvantageous are the quite high costs, especially for a short-time application, but in cases like the one presented, those costs are justified.

However, the described technique gives surgeons the possibility to operate patients with severe heart failure in comparable difficult situations.

	References

Top References

 

1. Farhat F, Sassard T, Attof Y, Jegaden O. Abdominal aortic aneurysm surgery with mechanical support using the Impella microaxial blood pump. Interact CardioVasc Thorac Surg 2008;7:524–526.[Abstract/Free Full Text]
2. Cowie AG, Ashleigh RJ, England RE, McCollum CN. Endovascular aneurysm repair with the Talent Stent-Graft. J Vasc Interv Radiol 2003;14:1011–1016.[Medline]
3. Scurr JRH, Brennan JA, Gilling-Smith GL, Harris PL, Vallabhaneni SR, McWilliams RG. Fenestrated endovascular repair for juxtarenal aortic aneurysm. Br J Surg 2008;95:326–332.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Theodor Tirilomis Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tirilomis, T. Search for Related Content PubMed Articles by Tirilomis, T. Related Collections Related Article