Severe aortic valve regurgitation requiring mechanical aortic valve replacement following Impella device implantation

Abstract

Introduction: We describe a patient who developed severe aortic regurgitation following Impella left ventricular assist device implantation requiring aortic valve replacement. Case report: A previously healthy 34-year-old female presented with chest pain and flu-like symptoms. Electrocardiogram showed widespread ST elevation and serum troponin was raised, consistent with myocarditis. Coronary angiography was normal but the right coronary artery dissected. Subsequent cardiogenic shock required veno-arterial extracorporeal membrane oxygenation and Impella implantation. Myocardial function recovered, but upon removal of the Impella, severe aortic regurgitation was present and she underwent aortic valve replacement, making a full recovery. Discussion: Aortic regurgitation is a rare complication of Impella implantation, and to our knowledge, this is the first reported case successfully treated with aortic valve replacement. Veno-arterial extracorporeal membrane oxygenation and Impella used in tandem are relatively novel, and may add synergistic benefit to strategies for acute cardiogenic shock. Conclusion: Echocardiography must include frequent assessment of both valvular and myocardial function after Impella removal.

Regurgitation during the fully supported condition of the percutaneous left ventricular assist device

“…The present study attempted to determine whether the short-term use of a percutaneously placed catheter pump in an unstable position would be associated with regurgitation in the fully supported state. To our knowledge, this is the first study of regurgitation associated with device displacement, although there are several reports of possible valvulopathy after PLVAD removal and possible trauma resulting in regurgitation during insertion, repositioning, or removal of the pump (Sef et al 2021, Vila et al 2021.…”

Valvular complications following the Impella device implantation

“…There are various contributing factors that can be considered that may lead to AR (Table 1). Recent studies have described several mechanisms that can cause injury of the AV during the implantation, repositioning, and removal of the Impella device 9,13,17 . The aortic valve might be damaged by the stiff guidewire during the insertion or with the Impella device itself following the guidewire going through the leaflet.…”

Acute native aortic regurgitation: clinical presentation, diagnosis and management

“…Fenestrations are focal areas of myxomatous degeneration located peripherally along valve commissure lines that can rupture, disrupting leaflet function 7 8. Iatrogenic complications include leaflet incompetence secondary to balloon aortic valvuloplasty, placement of a catheter across the aortic valve or a transaortic ventricular assist device 9–12…”