Aortic Valve Leaflet Disruption: A Severe Complication of Impella 5.5

Abstract

A 73-year-old male with a history of severe coronary artery disease and prior coronary artery bypass grafting (CABG) presented with chest pain and elevated troponins. His workup revealed an ejection fraction of 15%, severe native coronary disease, as well as stenosis of his bypass grafts. He underwent a high-risk redo CABG with an Impella 5.5® (Abiomed, Danvers, MA) placement. The device was removed on postoperative day eight, at which time he went into cardiogenic shock from aortic valve leaflet injury. Given that he had no calcium deposits around the aortic valve annulus and severe aortic insufficiency, a multidisciplinary heart team decided he would be best served by a surgical aortic valve replacement. He was taken back to the operating room for a surgical aortic valve and intra-aortic balloon pump. His postoperative course was complicated by pneumonia, sepsis, and renal failure requiring continuous renal replacement therapy. He was discharged to a rehabilitation facility after 42 days. The following case encompasses the high morbidity risk of acute aortic valve insufficiency after Impella placement, never before documented in an Impella 5.5.

Perioperative Use of Impella 5.0/5.5 in High-Risk Coronary Artery Bypass Grafting

“…There are some complications that are specifically related to Impella 5.0/5.5 use. Ghannam and colleagues reported a case of aortic valve injury related to the Impella 5.5 use [32]. The Impella 5.5 was removed on postoperative day 8, and the patient went into cardiogenic shock due to aortic valve leaflet injury, which required aortic valve replacement.…”