Harada Rakushumimarika, George Timothy J, Schaffer Justin, Kabra Nitin, Rawitscher David, Afzal Aasim
Division of Cardiology, Baylor Scott and White the Heart Hospital Plano, 1100 Allied drive, Plano, TX 75093, USA.
Division of Cardiothoracic Surgery, Baylor Scott and White the Heart Hospital Plano, 1100 Allied drive, Plano, TX 75093, USA.
Eur Heart J Case Rep. 2023 Aug 11;7(8):ytad381. doi: 10.1093/ehjcr/ytad381. eCollection 2023 Aug.
Impella is a transaortic valvular pump commonly utilized in patients with cardiogenic shock. However, its use with transcatheter aortic valves (TAVI) remains rare. We present two cases where surgical Impella 5.5 was placed across both Sapien 3 Ultra and Evolute Pro+ valves.
: A 74-year-old male with history of ischaemic cardiomyopathy with ejection fraction 20-25% status post-cardiac resynchronization therapy with a defibrillator, severe aortic stenosis (AS) status post-recent Sapien 3 Ultra TAVI presented with cardiogenic shock. Due to persistent unstable haemodynamic status, Impella 5.5 was placed and was utilized as a bridge to left ventricular assist device. : A 74-year-old male with a history of alcoholic cirrhosis and AS underwent Evolute Pro+ TAVI at outside facility. The implantation was complicated by left main coronary artery occlusion, leading to cardiogenic shock. Patient required femoral veno-arterial extracorporeal membrane oxygenation (ECMO) support and emergent single vessel coronary bypass of a saphenous venous graft to the left anterior descending artery. Extracorporeal membrane oxygenation was decannulated on Day 20 and Impella 5.5 was placed as a bridge to recovery. In both cases, there were no procedural complications or residual aortic or perivalvular regurgitation.
Impella 5.5 implanted via the axillary surgical cutdown is safe and feasible approach to manage refractory cardiogenic shock in patients with TAVI including different types of valves, Sapien 3 Ultra, and Evolute Pro+. As it can provide full haemodynamic support, Impella 5.5 can be used as bridge to recovery or durable mechanical support.
Impella是一种经主动脉瓣的泵，常用于心源性休克患者。然而，它与经导管主动脉瓣（TAVI）联合使用的情况仍然很少见。我们报告两例通过外科手术将Impella 5.5放置在Sapien 3 Ultra和Evolute Pro+瓣膜上的病例。
一名74岁男性，有缺血性心肌病病史，射血分数为20%-25%，接受心脏再同步治疗并植入除颤器，近期接受Sapien 3 Ultra TAVI后出现严重主动脉瓣狭窄（AS），并发心源性休克。由于血流动力学状态持续不稳定，置入了Impella 5.5，并用作左心室辅助装置的过渡。一名74岁男性，有酒精性肝硬化和AS病史，在外部机构接受了Evolute Pro+ TAVI。植入过程中并发左主干冠状动脉闭塞，导致心源性休克。患者需要股静脉-动脉体外膜肺氧合（ECMO）支持，并紧急进行单支血管冠状动脉搭桥，用大隐静脉移植至左前降支。体外膜肺氧合在第20天撤管，置入Impella 5.5作为恢复的过渡。在这两个病例中，均未出现手术并发症或残余主动脉瓣或瓣周反流。
通过腋窝手术切口置入Impella 5.5是一种安全可行的方法，可用于治疗TAVI患者（包括不同类型的瓣膜，如Sapien 3 Ultra和Evolute Pro+）的难治性心源性休克。由于Impella 5.5可以提供全面的血流动力学支持，它可以用作恢复的过渡或持久的机械支持。
