Abstract
BackgroundImpella® is an antegrade left ventricular assist device with a pump catheter in the left ventricle. We report three cases in which we experienced some pitfalls with circulatory management during Impella placement due to new-onset aortic insufficiency (AI) associated with device placement or the limited maximum flow rate.Case presentationThree patients developed new-onset AI due to Impella placement. In a patient, the total assisted flow rate was relatively low because of his large body size. In the other patients, in whom the Impella device was used in combination with percutaneous cardiopulmonary support or venoarterial extracorporeal membrane oxygenation (ECMELLA), total flow was maintained at a sufficient level.ConclusionsNew-onset of AI after Impella placement and its limited flow rate are considered to be pitfalls in circulatory management. Management with ECMELLA is considered to be effective during the acute phase when patients have decreased cardiac function.
Highlights
Impella® is an antegrade left ventricular assist device with a pump catheter in the left ventricle
Management with ECMELLA is considered to be effective during the acute phase when patients have decreased cardiac function
ICM ischemic cardiomyopathy, AMI acute myocardial infarction, FMC fulminant myocarditis, dHCM dilated phase of hypertrophic cardiomyopathy, BSA body mass index, PCPS percutaneous cardiopulmonary support, IABP intra-aortic balloon pumping, Venoarterial extra-corporeal membranous oxygenation (ECMO) extracorporeal membrane oxygenation, ABP arterial blood pressure, PAP pulmonary arterial pressure, CVP central venous pressure, RSCA right subclavian artery, AsAo ascending aorta, CCO continuous cardiac output, CCI continuous cardiac index, AI aortic insufficiency, DOA dopamine, DOB dobutamine, NA noradrenaline *1Total flow rate is based on the sum of CCO determined with the thermodilution technique using the pulmonary artery catheter and PCPS flow rate *2Maintenance dose after leaving the operating room
Summary
New-onset of AI after Impella 5.0 placement and its limited flow rate are considered to be pitfalls in circulatory management. 4. Stainback RF, Estep JD, Agler DA, Birks EJ, Bremer M, Hung J, et al Echocardiography in the management of patients with left ventricular assist devices: recommendations from the American Society of Echocardiography. The physiology of continuous-flow left ventricular assist devices. AT responsible for this article assisted to prepare the manuscript and interpreted the data. KY assisted to prepare the manuscript and interpreted the data. All authors approved the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
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