Impella 5.0 repositioning across the aortic valve without a guidewire using rapid ventricular pacing: A case report. Issue 11 (27th July 2020)

• Record Type: Journal Article
• Authors: Masiello, Paolo; Frunzo, Francesco; Padula, Marco; Mastrogiovanni, Generoso; Triggiani, Donato; Laudani, Alessandro; Leone, Rocco; Iesu, Severino
• Is Part Of: Journal of cardiac surgery. Volume 35:Issue 11(2020)
• Page Start: 3157
• Page End: 3159
• Publication Date: 2020-07-27
• Subjects: coronary artery disease -- perfusion -- surgical history; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.14713
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background: Displacement of Impella 5.0 secondary to patient movement or transportation is a well‐known complication. Typically, repositioning of an Impella across the aortic valve is attempted over a guidewire. We present the first case, to our knowledge, of repositioning a dislodged Impella 5.0 without a guidewire under transesophageal echocardiography (TEE) guidance, by inducing rapid ventricular pacing to cross the aortic valve. Case Presentation: A 70‐year‐old man with low left ventricular ejection fraction underwent off‐pump coronary artery bypass grafting. On 2nd postoperative day a low cardiac output state developed with increasing lactate levels and consequently the patient was taken to the cardiac catheterization laboratory for insertion of an Impella 5.0. Suddenly the Impella system failed with a rapid hemodynamic deterioration and it was successfully bedside repositioned inducing rapid ventricular pacing. Conclusions: In case of accidental Impella dislodgement and fast deterioration of the patient's hemodynamic status, rapid pacing may be an option to "open" the aortic valve thus aiding quick replacement of Impella 5.0 through the aortic valve into the left ventricle under TEE guidance.