Aortic insufficiency associated with Impella that required surgical intervention upon implantation of the durable left ventricular assist device

Oishi, Hideo; Kondo, Toru; Fujimoto, Kazuro; Mutsuga, Masato; Morimoto, Ryo; Hirano, Ken‐ichi; Sawamura, Akinori; Kazama, S.; Kimura, Yuki; Shibata, Naoki; Kato, Hiroo; Arao, Yoshihito; Kuwayama, Tasuku; Yamaguchi, Shogo; Hiraiwa, Hiroaki; Okumura, Takahiro; Usui, Akihiko; Murohara, Toyoaki

doi:10.1007/s10047-020-01184-x

Cited by 8 publications

(15 citation statements)

References 11 publications

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“…[8][9][10][11][12]16,17 For example, Oishi et al describe two cases of AI caused by Impella 5.0 devices for two patients supported for 91 and 98 days. 12 In both of these cases, patients underwent at least one Impella LVAD exchange procedure; although one patient developed AI only after the final device was removed, the other patient developed AI during Impella LVAD support. 12 Similarly, Chandola et al describe a case of severe AI development after leaflet damage during Impella 5.0 explantation.…”

Section: Discussionmentioning

confidence: 99%

“…Worsening AI is particularly problematic with the use of some types of mechanical circulatory support and requires valve procedures for durable LVAD implantation. 12,13 To our knowledge, no studies have been performed to assess how common valvular complications are among Impella 5.0 and Impella CP devices. This study seeks to clarify the relationship and incidence between Impella LVAD use and secondary AR and MR, with an emphasis on Impella 5.0 and Impella CP use.…”

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confidence: 99%

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The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency

et al. 2021

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Impella left ventricular assist devices (LVADs) (Abiomed, Danvers, MA) are implanted in the left ventricle across the aortic valve. Several cases of secondary aortic insufficiency (AI) or mitral regurgitation (MR) after Impella LVAD use have been reported. Secondary valvulopathies can worsen cardiac function. This single center retrospective study sought to characterize the incidence of secondary AI and MR development after Impella LVAD support. One hundred fifty-two patients who underwent Impella LVAD support between April 2014 and August 2019 were included. Patient demographics, implant indications, duration of support, pre- and post-Impella LVAD echocardiograms, and incidence of increased AI/MR were analyzed. Impella 5.0 and Impella CP were subanalyzed. Following exclusion criteria, AI and MR were analyzed in 93 and 78 patients, respectively. An increase in AI and MR was seen in 17.2% and 12.8% of patients with an event per support days of 0.03 and 0.02, respectively. Clinically significant increases in AI and MR were seen in 3.2% (n = 3), 6.4% (n = 5), respectively. The incidences of increased AI (p = 0.33) and MR (p = 0.45) were similar between Impella 5.0 and Impella CP patients. Worsening AI and MR clinically occur at a low incidence with Impella LVAD use. However, careful follow-up is still warranted.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency

et al. 2021

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“…In another report, the severity of AI worsened in 14.7% of patients, which included 3.3% of patients with new severe AI within 24 hours of Impella device support [ 5 ]. Since AI during LVAD support would cause recirculation and decreases LVAD efficiency, surgical treatment would be considered if greater than mild AI had occurred in patients with LVADs [ 6 , 7 ]. Robertson et al.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve insufficiency after Impella device insertion that required aortic valve replacement after Heart Mate III left ventricular assist device implantation: a case report.

Ueda

Yoshitani

Hosotani

et al. 2021

Journal of Surgical Case Reports

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The Impella (Abiomed, Danvers, MA, USA) is a minimally invasive axial-flow catheter used in severe heart failure. We describe a case in which aortic insufficiency occurred after Impella insertion, required extra surgical intervention twice. A 33-year-old man with familial dilated cardiomyopathy was admitted to our hospital due to acute decompensation of heart failure. Despite intensive medical treatment, his hemodynamic status did not improve. Firstly, Impella was emergently implanted, and HeartMate III (Abbott, Plymouth, MN, USA) implantation was performed 2 weeks after. In the HeartMate III implantation, new aortic insufficiency had revealed and central aortic valve closure was performed concomitantly. However, on postoperative Day1, the coaptation stitch had untied, causing severe aortic insufficiency which led to another emergent operation of aortic valve replacement. We suggest that indications for Impella implantation need to be carefully discussed beforehand, especially with patients who may undergo implantation of left ventricular assist device.

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“…1 However, device-related complications, including hemolysis, stroke, limb ischemia, vascular complications, and valve injury have been reported. 2 Although rare, iatrogenic aortic valve (AV) injury can be caused by device placement across the valve, 1 , 3–6 which is not evident until after it is removed. A few case reports have described iatrogenic AV injury due to the Impella device implantation, but none have clarified the mechanism of injury.…”

Section: Introductionmentioning

confidence: 99%

Aortic valve replacement after iatrogenic injury related to an Impella device

Saitoh

Kin

2020

Asian Cardiovasc Thorac Ann

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The Impella device is used routinely during coronary interventions, and device-related iatrogenic injury requiring surgical repair is rarely reported. We report a case of iatrogenic aortic valve injury due to Impella device insertion, necessitating aortic valve replacement surgery. A 55-year-old woman with acute anteroseptal myocardial infarction underwent a successful percutaneous coronary intervention and Impella insertion for hemodynamic support. Four months later, she experienced congestive heart failure; transthoracic echocardiography revealed new-onset severe aortic insufficiency. Aortic valve replacement was performed without complications. Follow-up transthoracic echocardiography should be performed after Impella removal to avoid delay in treating residual aortic insufficiency.

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Aortic insufficiency associated with Impella that required surgical intervention upon implantation of the durable left ventricular assist device

Cited by 8 publications

References 11 publications

The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency

The Effects of Percutaneous Left Ventricular Assist Device Placement on Native Valve Competency

Aortic valve insufficiency after Impella device insertion that required aortic valve replacement after Heart Mate III left ventricular assist device implantation: a case report.

Aortic valve replacement after iatrogenic injury related to an Impella device

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