Prosthetic valve replacement for aortic leaflet tear secondary to Impella device placement

We experienced a case of aortic regurgitation secondary to tear in the non-coronary cusp of the aortic valve after percutaneous mechanical circulatory support by Impella 2.5 placement, which was resolved with aortic valve replacement. Our patient, a 72-year-old man, developed non-ST elevation myocardial infarction and cardiogenic shock, which was treated with the implantation of Impella 2.5 prior to percutaneous coronary intervention. He eventually required prosthetic valve replacement for progressive aortic regurgitation after removing the Impella device. From intraoperative photographs, multiple lacerations were confirmed in the non-coronary aortic cusp. One year after prosthetic valve replacement, he was asymptomatic as per the New York Heart Association functional class II; additionally, echocardiography showed a mean prosthetic valve gradient of 7 mmHg, an effective orifice area of 1.87 cm², and no aortic regurgitation. A rare complication of aortic regurgitation due to aortic valve injury should be considered when hemodynamic deterioration is observed after Impella implantation.