Impella 5.5 Use in the Setting of Severe Aortic Insufficiency: A Relative Contraindication

Moderate or severe aortic insufficiency is a contraindication to transvalvular Impella left ventricular assist device (Abiomed) use out of concern for worsening valvular insufficiency and recirculation. This report describes the case of a 75-year-old man with severe eccentric aortic insufficiency and systemic hypoperfusion who was supported with a transvalvular Impella 5.5 device for 6 days as preoperative rehabilitation before aortic valve replacement. The Impella device provided adequate systemic tissue perfusion, and left ventricular function remained without signs of volume overload and recirculation. Moderate or severe aortic insufficiency may not be an absolute contraindication to transvalvular Impella use, although this is case dependent.