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Mechanical circulatory support in the context of coronary artery bypass grafting

Guo, Ming Haoa; Vo, Thin Xuana; Pham, Ducb; Toeg, Hadia

doi: 10.1097/HCO.0000000000000685
CORONARY ARTERY SURGERY: Edited by Marc Ruel
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Purpose of review With the continuous innovation in mechanical circulatory support as an option for the management of patients in cardiogenic shock from myocardial infarction, it is important to understand the current evidence and recommendations for the use of these devices for patients who require or underwent coronary artery bypass surgery.

Recent findings The use of mechanical circulatory support (MCS) in patients with cardiogenic shock who require or underwent coronary artery bypass surgery has not been well studied. Observational studies have shown that the use of intra-aortic balloon pump or percutaneous ventricular assist devices prior to revascularization lead to better survival. Extracorporeal membrane oxygenation (ECMO) still carries significant risk of mortality and complications; the use of additional MCS devices for left ventricular unloading during ECMO improves outcomes.

Summary MCS will continue to play an important role in coronary artery surgery patients. Multidisciplinary Cardiac Shock Team can assist in proper patient selection and device choice, whereas prospective clinical trials are required to provide evidence-based guidance towards the management of these patients.

aDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

bDivision of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA

Correspondence to Hadi Toeg, MD, MSc, MPH, FRCSC, Assistant Professor, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada. Tel: +1 613 696 4091; e-mail: HToeg@OttawaHeart.ca

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