Use of Impella 5.0 Prior to Transcatheter Aortic Valve Replacement in a Patient with Severe Aortic Stenosis and Cardiogenic Shock

Abstract

The use of transcatheter aortic valve replacement (TAVR) has risen dramatically during the past decade. Notably, the procedure can reduce symptoms and improve prognosis in patients who would otherwise be excluded from intervention due to prohibitive surgical risk. During the same time period, the use of percutaneous mechanical circulatory support devices for patients with severe left ventricular dysfunction, including the Impella System (Abiomed, Inc., Danvers, MA, USA), has also increased. These devices provide superior hemodynamic effects compared to intra-aortic balloon pumping. However, data relating to use of the Impella in patients with both severe left ventricular dysfunction and significant aortic valve disease are limited. Herein is presented the case of a 59-year-old man with severe aortic stenosis and cardiogenic shock who was treated successfully with an Impella 5.0 as a temporizing measure prior to TAVR. A brief review is also provided of the use of mechanical circulatory support devices in this subset of patients. Video 1: Transesophageal echocardiography video demonstrating stenotic aortic valve pre-intervention in side-by-side long and short axes. Video 2: Transthoracic echocardiography video, parasternal short axis, demonstrating Impella 5 in the left ventricle. Video 3: Fluoroscopy video demonstrating deployment of the Edwards SAPIEN transcatheter aortic valve. Video 4: Transesophageal echocardiography video showing the Edwards SAPIEN transcatheter aortic valve in long axis. Video 5: Transesophageal echocardiography video showing the Edwards SAPIEN transcatheter aortic valve in short axis.