Device fracture as a potential complication of a left ventricular microaxial pump catheter: a case report

Abstract

Background The use of Impella pump catheter has advanced substantially in the last years due to the simple insertion procedure and smaller device size. However, its use is still associated with some risks and complications. Here, we report a device fracture as a rare complication occurred during the device extraction a few days after the initial insertion. Case summary A 74-year-old man with cardiogenic shock due to acute non-ST-segment elevation myocardial infarction was presented to our hospital and transferred to the cath lab for emergency percutaneous coronary intervention (PCI). An Impella CP pump was inserted without any complication prior to PCI. After successful PCI the patient was transferred to the intensive care unit with device left for continued hemodynamic support. After 3 days, as the patient’s condition has remarkably improved, we tried to remove the device. However, a persistent mechanical resistance hindered the further catheter retraction, therefore, the decision was made to remove the catheter under fluoroscopy. Indeed, the fluoroscopy revealed that the broken distal part of the pump at the level of the ascending aorta. The retained catheter tip was eventually snared with a snare catheter and removed without any complication. Discussion Impella microaxial pump may improve the overall outcome by providing the hemodynamic support in critically ill patients. However, its application is not without complication. Intravascular device tip fracture, as demonstrated in this case report, is a rarely reported complication. The use of snare catheter can be an option in retrieving the broken pump.