Hemodynamic Support with Impella 2.5 during Balloon Aortic Valvuloplasty in a High-Risk Patient

Abstract

Aortic stenosis (AS) has been considered an exclusion criterion for the use of the Impella 2.5 catheter. We describe a case in which the Impella catheter was successfully implanted and used for hemodynamic support during balloon aortic valvuloplasty in a high-risk patient of severe AS with a calculated aortic valve area of 0.59 cm2 .

Feasibility and efficacy of the 2.5 L and 3.8 L impella percutaneous left ventricular support device during high‐risk, percutaneous coronary intervention in patients with severe aortic stenosis

“…The Impella catheter is relatively contraindicated in severe AS due to theoretical concerns that the catheter may reduce effective valve orifice area or induce valvular incompetence and so precipitate cardiovascular collapse. However, three case reports and a recent small case series have suggested that Impella may be safely used in patients with moderate or severe AS .…”

Percutaneous Mechanical Ventricular Support in Acute Cardiac Care: A UK Quaternary Centre Experience Using 2.5L, 3.8L and 5.0L Impella Catheters

“…However, with increasing experience there have been anecdotal reports [33, 34] and a recent series [35] describing the use of Impella in this setting. The use of Impella in our patients with severe AS is an example of the expanding indication for this device.…”

UDP‐N‐acetylglucosamine biosynthesis in lactobacilli

“…IABP, on the other hand, remains limited to provide <1.5 L min −1 flow rates and requires a cardiac rhythm or pressure wave to generate its pulsatile function. The use of retrograde LV support with Impella in patients with AS has not been well described and only single case reports are available [15, 16].…”

“…In fact, a significant increase in arterial pressure was noted when the pump was run at its maximum level (P8). Previously, Londoño et al described the first use of Impella support during BAV in a patient with LV dysfunction [16]. In that report, a bench‐model Impella‐BAV simulation was done by installing a 23‐mm BAV balloon and Impella cannula into a 21‐mm polyurethane valve conduit.…”

“…The Impella 2.5 is capable of providing up to 2.5 L min −1 of continuous forward flow from the LV into the ascending aorta, thus unloading the LV and improving coronary perfusion [12]. Patients with AS have been excluded from previous trials with Impella; hence, there is a paucity of data on the use of this percutaneous device in high‐risk patients with AS requiring hemodynamic support, and only a few cases have recently been reported [15, 16].…”