A Case of Severe Triple Vessel Disease Treated with Coronary Artery Bypass Grafting Using Impella

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe triple-vessel coronary artery disease with heart failure and cardiogenic shock due to subacute myocardial infarction (n=1). Intervention: Coronary artery bypass grafting (CABG) with perioperative Impella CP circulatory support. Primary outcome: Hemodynamic stabilization, successful surgical revascularization without circulatory collapse, and postoperative recovery.

Q: What does this research mean for the field?

Perioperative Impella CP support effectively stabilizes hemodynamics as a feasible bridge to coronary artery bypass grafting in patients with severe triple-vessel disease and acute heart failure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Suguru Matsui; Noriyuki Takashima; Fumihiro Miyashita; Shunta Miwa; Yuji Matsubayashi; Shintaro Okuda; Bruno Yuji Chimada; Chihiro Yokoyama; Taku Tanaka; Tomoaki Suzuki

doi:10.4326/jjcvs.55.226

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

A Case of Severe Triple Vessel Disease Treated with Coronary Artery Bypass Grafting Using Impella

View Full Paper

Ask AI

Bookmark

Share

Key result

Impella CP successfully bridges high-risk CABG, stabilizing hemodynamics and improving LVEF to ~48%.

n=1

Why the study?

The perioperative indications for Impella circulatory support in patients undergoing coronary artery bypass grafting remain unclear in many respects.

Does perioperative Impella CP support maintain hemodynamic stability and enable successful coronary artery bypass grafting in a patient with severe triple-vessel disease, impaired left ventricular function, and cardiogenic shock due to subacute myocardial infarction?

Key Points

To describe the successful application of an Impella CP mechanical circulatory support device to stabilize hemodynamics before and during coronary artery bypass grafting in a patient with severe ischemic heart disease.
A 66-year-old man presented with loss of consciousness, severe triple-vessel coronary artery disease, and heart failure with cardiogenic shock following subacute myocardial infarction.
An Impella CP device was inserted to establish mechanical circulatory support and decongest pulmonary circulation prior to surgery.
Coronary artery bypass grafting was performed on hospital day 5 under continuous Impella support maintained at performance level P3.
Preoperative Impella support and medical therapy relieved pulmonary congestion, reduced pulmonary artery pressure from 43 mmHg to approximately 25 mmHg, and normalized elevated lactate levels.
The 5-hour and 38-minute surgical revascularization was completed without circulatory collapse under stable P3 Impella support, and the device was explanted on postoperative day 2.
Left ventricular ejection fraction reached 48% by postoperative day 10, and the patient was discharged walking independently on postoperative day 28.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does perioperative Impella CP support maintain hemodynamic stability and enable successful coronary artery bypass grafting in a patient with severe triple-vessel disease, impaired left ventricular function, and cardiogenic shock due to subacute myocardial infarction?

P

Population

1 male patient aged 66 years with severe triple-vessel coronary artery disease, impaired left ventricular function, and cardiogenic shock following subacute myocardial infarction, followed for 6 months post-discharge.

I

Intervention

Impella CP circulatory support initiated on admission as a bridge to surgery (stabilized over 5 days) and maintained intraoperatively at support level P3 during off-pump coronary artery bypass grafting (CABG using skeletonized LITA to #8, SVG to #4PD and #14, and free GEA to HL), followed by Impella removal and temporary IABP placement on postoperative day 2 (removed on day 3).

O

Outcome

Perioperative hemodynamic stability without circulatory collapse and survival to hospital dischargehard clinical

This case report demonstrates that preoperative and intraoperative Impella CP support can effectively stabilize hemodynamics as a bridge to surgery and prevent intraoperative circulatory collapse during off-pump CABG in a patient with cardiogenic shock and severe triple-vessel disease.

Limitations

Single-patient case report limiting generalizability
Optimal indications, duration, and management protocols for perioperative Impella support as a bridge to cardiac surgery remain unclear
Limited institutional experience with Impella prompted precautionary post-extubation IABP placement that may not have been strictly necessary
Optimal indications, duration, and management strategies for perioperative Impella use as a bridge to cardiac surgery remain unclear and require validation in larger-scale studies.
Limited institutional experience with Impella led to precautionary IABP placement after Impella removal, which may not be strictly necessary given the stable course.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support Impella bridging in select high-risk CABG; leaves open need for prospective trials before wider adoption.

Abstract

症例は66歳，男性．一過性意識消失を主訴に救急要請された．冠動脈に3枝病変を認め，亜急性心筋梗塞による心不全と診断された．低左心機能・多枝病変であり，Impella CPを留置し循環動態の安定を図った後に冠動脈バイパス術による血行再建を施行した．Impellaによる補助下において循環動態の破綻をきたすことなく手術を完遂し，術後経過も良好で独歩退院となった．周術期におけるImpellaの適応については未解明な点も多いが，本症例においては適切な循環補助デバイスとして有用であったため報告する．

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Matsui et al. (2026) conducted a case report in Severe triple-vessel coronary artery disease with heart failure and cardiogenic shock due to subacute myocardial infarction (n=1). Coronary artery bypass grafting (CABG) with perioperative Impella CP circulatory support was evaluated on Hemodynamic stabilization, successful surgical revascularization without circulatory collapse, and postoperative recovery. Perioperative Impella CP support successfully stabilized hemodynamics as a bridge to CABG in a 66-year-old man with triple-vessel disease, improving LVEF to 48% and enabling ambulatory discharge on day 28.

synapsesocial.com/papers/6af0e999de503f3774140a4c https://doi.org/10.4326/jjcvs.55.226

View Full Paper

Ask AI

Bookmark

Share

A Case of Severe Triple Vessel Disease Treated with Coronary Artery Bypass Grafting Using Impella

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Severe Triple Vessel Disease Treated with Coronary Artery Bypass Grafting Using Impella

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading