Temporary Mechanical Circulatory Support in High-Risk Cardiac Surgery: Contemporary Practice and Insights From U.S. Transplant Centers.
Publication/Presentation Date
8-24-2026
Abstract
BACKGROUND: To date, evidence regarding the role of temporary mechanical circulatory support (tMCS) for high-risk cardiac surgery (HRCS) is limited and continues to evolve. We aimed to appraise current evidence and characterize contemporary use of tMCS in HRCS across selected U.S. Transplant Centers.
METHODS: The authors have conducted a cross-sectional survey for tMCS use for HRCS. This survey was conducted using the RedCap system evaluating the timing of support, device selection, and technical considerations. The response rate was 74%.
RESULTS: For isolated coronary artery bypass grafting (CABG) patients with left ventricular ejection fraction (LVEF) 25%-35%, no-tMCS and intra-aortic balloon pump were the common approaches. In isolated CABG patients with LVEF less than 25%, more surgeons consider tMCS use including Impella 5.5. For CABG with mitral repair or replacement, more surgeons consider the use of tMCS. The annual volume of Impella 5.5 use for HRCS cases was ≤ 10 cases annually. For arterial access for Impella 5.5, the rate of trans-aortic and trans-axillary approach were equal. For HRCS, the simultaneous approach was more predominant, and most surgeons advance Impella to the left ventricle after the cross-clamp is off. Most surgeons leave Impella 5.5 for 72 h to 1 week. For patients with severe aortic insufficiency, one-fourth of surgeons have performed Impella 5.5 insertion.
CONCLUSIONS: Contemporary practice demonstrates increasing adoption of tMCS use in HRCS with a trend toward preemptive implementation of support. Given limited high-quality evidence and variability in practice, careful patient selection, technical expertise, and institutional experience remain critical to achieving optimal results.
ISSN
1525-1594
Published In/Presented At
Ohira, S., Spencer, P. J., Tavolacci, S. C., Omar, Y. A., & Collaborators (2026). Temporary Mechanical Circulatory Support in High-Risk Cardiac Surgery: Contemporary Practice and Insights From U.S. Transplant Centers. Artificial organs, 10.1111/aor.70227. Advance online publication. https://doi.org/10.1111/aor.70227
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42638227
Department(s)
Administration and Leadership
Document Type
Article