{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:21:08Z","timestamp":1791231668681,"version":"4.1.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":300,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiopulmonary bypass (CPB) is the standard approach for coronary artery bypass grafting (CABG) in advanced ischaemic cardiomyopathy. Microaxial pump support has been envisioned to allow for beating-heart CABG without CPB (MPCAB), thereby avoiding CPB-inherent complications. This study aims to compare the in-hospital and follow-up outcome of MPCAB versus CPB-CABG in patients with severely impaired left ventricular function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Eleven patients suffering from three-vessel coronary artery disease with median ejection fraction of 27% and deemed appropriate for CABG according to a heart team decision underwent MPCAB (support up to 5.5 L\/min). Propensity score matching generated a CPB-CABG control group (n = 33). The primary endpoint was defined as death from any cause by the end of the follow-up (up to 4 years). MPCAB enabled continuous intraoperative and postoperative haemodynamic stabilization and complete myocardial revascularization. After CPB-CABG, additional mechanical circulatory support was required in 45.5% (vs. 9.1% in MPCAB; P = 0.0363). The follow-up all-cause mortality after MPCAB amounted to 0% (vs. 33.3% after CPB-CABG; P = 0.0414; NNT = 3). MPCAB patients showed a significantly decreased occurrence of major adverse cardiovascular events (MACE: 0% vs. 39.4%; P = 0.0189).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MPCAB allows for complete surgical revascularization without the necessity of extracorporeal circulation in spite of severely impaired left ventricular function. This first comparative study on the outcome after MPCAB versus CPB-CABG demonstrates a significantly decreased risk of death as well as MACE in MPCAB patients. The MPCAB concept expands the spectrum of patients eligible for CABG without CPB towards patients with severely impaired left ventricular function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15261","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T20:33:45Z","timestamp":1745526825000},"page":"2749-2758","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Microaxial Pump-Supported Coronary Surgery without CPB to Optimize Outcome in Severely Impaired Left Ventricles"],"prefix":"10.1093","volume":"12","author":[{"given":"Anna Kathrin","family":"Assmann","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve","family":"Arik-Doganay","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Wa\u00dfenberg","sequence":"additional","affiliation":[{"name":"punkt05 Statistics Consultants, Life Science Centre , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payam","family":"Akhyari","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University , Duesseldorf ,","place":["Germany"]},{"name":"Department for Thoracic and Cardiovascular Surgery, University Hospital Essen , Essen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Lichtenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3777-7772","authenticated-orcid":false,"given":"Alexander","family":"Assmann","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2026021804132388100_ehf215261-bib-0001","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1056\/NEJMoa1602001","article-title":"Coronary-artery bypass surgery in patients with ischemic cardiomyopathy","volume":"374","author":"Velazquez","year":"2016","journal-title":"N Engl J Med"},{"key":"2026021804132388100_ehf215261-bib-0002","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.116.003255","article-title":"Survival benefits of invasive versus conservative strategies in heart failure in patients with reduced ejection fraction and coronary artery disease: a meta-analysis","volume":"10","author":"Wolff","year":"2017","journal-title":"Circ Heart Fail"},{"key":"2026021804132388100_ehf215261-bib-0003","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1093\/ejcts\/ezaa319","article-title":"Treatment strategies in ischaemic left ventricular dysfunction: a network meta-analysis","volume":"59","author":"Gaudino","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026021804132388100_ehf215261-bib-0004","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.jacc.2017.12.024","article-title":"Coronary artery bypass surgery improves outcomes in patients with diabetes and left ventricular dysfunction","volume":"71","author":"Nagendran","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0005","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1001\/jamacardio.2020.0239","article-title":"Long-term outcomes in patients with severely reduced left ventricular ejection fraction undergoing percutaneous coronary intervention vs coronary artery bypass grafting","volume":"5","author":"Sun","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0006","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.amjcard.2017.11.035","article-title":"Comparison of outcomes for off-pump versus on-pump coronary artery bypass grafting in low-volume and high-volume centers and by low-volume and high-volume surgeons","volume":"121","author":"Benedetto","year":"2018","journal-title":"Am J Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0007","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.athoracsur.2013.03.098","article-title":"Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the Society of Thoracic Surgeons national database","volume":"96","author":"Keeling","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2026021804132388100_ehf215261-bib-0008","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jtcvs.2018.02.111","article-title":"Implementation of the aortic no-touch technique to reduce stroke after off-pump coronary surgery","volume":"156","author":"Albert","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021804132388100_ehf215261-bib-0009","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1016\/j.jacc.2016.11.071","article-title":"Coronary artery bypass grafting with and without manipulation of the ascending aorta","volume":"69","author":"Zhao","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0010","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1111\/aor.14646","article-title":"Clinical outcomes of hundred large Impella implantations in cardiogenic shock patients based on individual clinical scenarios","volume":"47","author":"Sugimura","year":"2023","journal-title":"Artif Organs"},{"key":"2026021804132388100_ehf215261-bib-0011","doi-asserted-by":"publisher","first-page":"253","DOI":"10.2217\/fca-2021-0046","article-title":"Efficacy and safety of Impella 5.0 in cardiogenic shock: an updated systematic review","volume":"18","author":"Bossi","year":"2022","journal-title":"Future Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0012","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/s10047-021-01285-1","article-title":"Coronary artery bypass grafting under sole Impella 5.0 support for patients with severely depressed left ventricular function","volume":"25","author":"Katahira","year":"2022","journal-title":"J Artif Organs"},{"key":"2026021804132388100_ehf215261-bib-0013","volume-title":"Operative Techniques in Coronary Artery Bypass Surgery: An Illustrated Guide to Personalized Therapy","author":"Albert","year":"2020"},{"key":"2026021804132388100_ehf215261-bib-0014","doi-asserted-by":"publisher","first-page":"2231","DOI":"10.1016\/j.jacc.2018.08.1038","article-title":"Fourth universal definition of myocardial infarction (2018)","volume":"72","author":"Thygesen","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0015","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"2026021804132388100_ehf215261-bib-0016","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1214\/09-STS313","article-title":"Matching methods for causal inference: a review and a look forward","volume":"25","author":"Stuart","year":"2010","journal-title":"Stat Sci"},{"key":"2026021804132388100_ehf215261-bib-0017","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1214\/08-STS254","article-title":"Covariate balance in simple, stratified and clustered comparative studies","volume":"23","author":"Hansen","year":"2008","journal-title":"Stat Sci"},{"key":"2026021804132388100_ehf215261-bib-0018","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1093\/ejcts\/ezab449","article-title":"Post-pericardiotomy syndrome: insights into neglected postoperative issues","volume":"61","author":"Maranta","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026021804132388100_ehf215261-bib-0019","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.831930","article-title":"Inflammation and oxidative stress in the context of extracorporeal cardiac and pulmonary support","volume":"13","author":"Hatami","year":"2022","journal-title":"Front Immunol"},{"key":"2026021804132388100_ehf215261-bib-0020","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.jtcvs.2012.11.006","article-title":"Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery","volume":"147","author":"Park","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021804132388100_ehf215261-bib-0021","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1016\/j.resuscitation.2010.04.031","article-title":"Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: treatment strategies and predictors of short-term and midterm survival","volume":"81","author":"Wu","year":"2010","journal-title":"Resuscitation"},{"key":"2026021804132388100_ehf215261-bib-0022","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.029609","article-title":"Patient and management variables associated with survival after postcardiotomy extracorporeal membrane oxygenation in adults: the PELS-1 multicenter cohort study","volume":"12","author":"Mariani","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"2026021804132388100_ehf215261-bib-0023","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1097\/CCM.0000000000004922","article-title":"Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock-analysis of the extracorporeal life support organization registry","volume":"49","author":"Kowalewski","year":"2021","journal-title":"Crit Care Med"},{"key":"2026021804132388100_ehf215261-bib-0024","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.jtcvs.2009.10.043","article-title":"Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock","volume":"139","author":"Rastan","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026021804132388100_ehf215261-bib-0025","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.ijcard.2017.03.120","article-title":"Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: results of a multicenter study","volume":"241","author":"Biancari","year":"2017","journal-title":"Int J Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0026","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1002\/ehf2.13718","article-title":"Use of extracorporeal circulation (ECLS\/ECMO) for cardiac and circulatory failure -a clinical practice guideline level 3","volume":"9","author":"Assmann","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026021804132388100_ehf215261-bib-0027","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005853","article-title":"Early escalation of mechanical circulatory support stabilizes and potentially rescues patients in refractory cardiogenic shock","volume":"13","author":"Tongers","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2026021804132388100_ehf215261-bib-0028","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1002\/ejhf.668","article-title":"Concomitant implantation of Impella\u00ae on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock","volume":"19","author":"Pappalardo","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026021804132388100_ehf215261-bib-0029","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1007\/s00392-022-02069-0","article-title":"Venting during venoarterial extracorporeal membrane oxygenation","volume":"112","author":"Lusebrink","year":"2023","journal-title":"Clin Res Cardiol"},{"key":"2026021804132388100_ehf215261-bib-0030","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1016\/j.athoracsur.2024.01.017","article-title":"Mechanical circulatory support during surgical revascularization for ischemic cardiomyopathy","volume":"117","author":"Singh","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026021804132388100_ehf215261-bib-0031","doi-asserted-by":"publisher","first-page":"5168","DOI":"10.1002\/ehf2.13594","article-title":"Initial experience covering 50 consecutive cases of large Impella implantation at a single heart Centre","volume":"8","author":"Sugimura","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026021804132388100_ehf215261-bib-0032","doi-asserted-by":"publisher","DOI":"10.5761\/atcs.oa.23-00076","article-title":"Impact of Impella support on clinical outcomes in patients with postcardiotomy cardiogenic shock","volume":"30","author":"Sugimura","year":"2024","journal-title":"Ann Thorac Cardiovasc Surg"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/4\/2749\/66953964\/eschf_12_4_2749.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/4\/2749\/66953964\/eschf_12_4_2749.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:13:28Z","timestamp":1771406008000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/12\/4\/2749\/8488104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,24]]},"published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15261","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,4,24]]},"assertion":[{"value":"2024-07-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}