Management of Impella device fracture during direct aortic explantation

The utilisation of mechanical circulatory support devices in patients undergoing high-risk coronary artery bypass continues to increase. The Impella is a ventricular assist device commonly used in the setting of post-cardiotomy cardiogenic shock. This device can be implanted directly into the ascending aorta during open cardiac surgery. Device fracture is a documented complication of the Impella; however, the management of device fracture during direct explantation from an aortic graft has not yet been described. We report a case of Impella device fracture during its removal from a prosthetic aortic graft and discuss the management of this complication.