Emergent use of Impella CP™ during transcatheter aortic valve replacement: Transaortic access

Sudden onset of hypotension is a rare but emergent event in patients undergoing transcatheter aortic valve replacement (TAVR). This primarily occurs due to coronary artery obstruction, valve misplacement/migration, ventricular perforation, cardiac tamponade, severe paravalvular regurgitation, stunned myocardium, ventricular arrhythmia, and annulus rupture. While the operator makes an attempt to identify and correct the underlying problem, an emergent placement of mechanical hemodynamic assist device may be necessary and crucial for a successful outcome. We describe a unique and challenging case of complete circulatory collapse in a patient undergoing transaortic TAVR with Edwards SAPIEN prosthesis (Edwards Lifesciences, CA) who required rescue Impella CP™ (Abiomed, Danvers, MA) placement directly through the ascending aorta due to unfavorable femoral access.