A patient with extensive ST elevation myocardial infarction who underwent emergent Impella CP® assisted off-pump coronary artery bypass without mechanical complication

Yojiro Machii; Akira Sezai; Yuki Hayashi; Atsushi Harada; Keita Kamata; Naoki Eguchi; Masashi Tanaka

doi:10.1016/j.jccase.2023.11.008

A patient with extensive ST elevation myocardial infarction who underwent emergent Impella CP® assisted off-pump coronary artery bypass without mechanical complication

J Cardiol Cases. 2023 Dec 7;29(3):104-107. doi: 10.1016/j.jccase.2023.11.008. eCollection 2024 Mar.

Authors

Yojiro Machii¹, Akira Sezai¹, Yuki Hayashi¹, Atsushi Harada¹, Keita Kamata¹, Naoki Eguchi¹, Masashi Tanaka¹

Affiliation

¹ Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.

Abstract

Impella (Abiomed Inc., Danvers, MA, USA) assisted off-pump coronary artery bypass has been increasingly reported in recent years. However, there have been no reports of the procedures performed for acute myocardial infarction in which the patient is hemodynamically unstable. We report a case of a 73-year-old man with cardiogenic shock due to extensive ST elevation acute myocardial infarction that worsened despite Impella CP® support. Because of the fragile myocardium in the acute phase of myocardial infarction, Impella assisted off-pump coronary artery bypass graft causes a high risk of myocardial injury, but we were able to safely perform the procedure by ingenious techniques.

Learning objective: When performing Impella-assisted off-pump coronary artery bypass for extensive acute myocardial infarction patients, the high risk of mechanical complications due to myocardial fragility must be considered. The position of Impella should be carefully monitored intraoperatively, and elevation of cardiac apex should be kept to a minimum to prevent myocardial damage caused by Impella.

Keywords: Acute myocardial infarction; Impella; Mechanical complications; Off-pump coronary artery bypass.

Publication types

Case Reports