Aortic Valve Leaflet Disruption: A Severe Complication of Impella 5.5

Alexander D Ghannam,Manabu Takebe,Taylor S Harmon,John Pirris,Scott Tatum

doi:10.7759/cureus.13235

Abstract

A 73-year-old male with a history of severe coronary artery disease and prior coronary artery bypass grafting (CABG) presented with chest pain and elevated troponins. His workup revealed an ejection fraction of 15%, severe native coronary disease, as well as stenosis of his bypass grafts. He underwent a high-risk redo CABG with an Impella 5.5® (Abiomed, Danvers, MA) placement. The device was removed on postoperative day eight, at which time he went into cardiogenic shock from aortic valve leaflet injury. Given that he had no calcium deposits around the aortic valve annulus and severe aortic insufficiency, a multidisciplinary heart team decided he would be best served by a surgical aortic valve replacement. He was taken back to the operating room for a surgical aortic valve and intra-aortic balloon pump. His postoperative course was complicated by pneumonia, sepsis, and renal failure requiring continuous renal replacement therapy. He was discharged to a rehabilitation facility after 42 days. The following case encompasses the high morbidity risk of acute aortic valve insufficiency after Impella placement, never before documented in an Impella 5.5.

Highlights

Impella® (Abiomed, Danvers, MA) is a microaxial flow catheter that provides mechanical circulatory support for the short term, unloading the left ventricle in patients with cardiogenic shock [1,2]
The device was removed on postoperative day eight, at which time he went into cardiogenic shock from aortic valve leaflet injury
Given that he had no calcium deposits around the aortic valve annulus and severe aortic insufficiency, a multidisciplinary heart team decided he would be best served by a surgical aortic valve replacement

Summary

Introduction

Impella® (Abiomed, Danvers, MA) is a microaxial flow catheter that provides mechanical circulatory support for the short term (less than or equal to 14 days), unloading the left ventricle in patients with cardiogenic shock [1,2]. Regardless of size, the device is positioned with the inflow end of the catheter in the left ventricle, across the aortic valve, and with the outflow end of the catheter in the ascending aorta. How to cite this article Ghannam A D, Takebe M, Harmon T S, et al (February 09, 2021) Aortic Valve Leaflet Disruption: A Severe Complication of Impella 5.5. The multispectral color doppler image demonstrates retrograde flow from the ascending aorta (in blue) consistent with aortic regurgitation This is a three-dimensional echocardiographic image of the aortic valve with the arrow directed toward a tear of the left coronary leaflet. The patient's postoperative course was complicated by pneumonia and severe kidney injury requiring temporary dialysis He underwent tracheostomy and percutaneous gastrostomy tube placement and was eventually discharged to a rehabilitation facility after 42 days in the hospital

Discussion

Conclusions

Disclosures