Coronary Artery Bypass Surgery in a Patient With an Occluded Abdominal Aorta Supported by Microaxial Left Ventricular Assist Device

Coronary artery disease with severe left ventricular dysfunction presents perioperative challenges during bypass surgery when vascular access is limited. Traditional mechanical circulatory support options, such as intraaortic balloon pumps, may be unsuitable in patients with peripheral vascular disease. We present the case of a 63-year-old man with severe coronary artery disease with an occluded infrarenal aorta precluding standard device placement. An Impella 5.5 (Abiomed) was successfully implanted perioperatively via the left axillary artery. Although typically used in high-risk percutaneous coronary interventions and cardiogenic shock, this case highlights this device’s role in supporting low ejection fraction coronary artery bypass grafting.