Severe aortic valve regurgitation requiring mechanical aortic valve replacement following Impella device implantation. (April 2021)

• Record Type: Journal Article
• Authors: Vila, Pierre; de Vere, Felicity; Simon, André; Walker, Christopher
• Is Part Of: Perfusion. Volume 36:Number 3(2021)
• Page Start: 311
• Page End: 314
• Publication Date: 2021-04
• Subjects: veno-arterial extracorporeal membrane oxygenation -- cardiogenic shock mechanical circulatory support -- Impella -- aortic regurgitation -- aortic valve replacement; Perfusion (Physiology) -- Periodicals; Blood -- Circulation, Artificial -- Periodicals; Heart -- Surgery -- Periodicals; Extracorporeal Circulation -- Periodicals; Perfusion -- Periodicals; Circulation extracorporelle -- Périodiques; Perfusion -- Périodiques; 617.41
• DOI: 10.1177/0267659120941339
• Languages: English
• ISSNs: 0267-6591

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.