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Upfront Impella CP as Bridge-to-Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis and Cardiogenic
Dorian Garin1, Benjamin Assouline2, Sophie Degrauwe1
1Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
Insights
This case study shows that using Impella CP before transcatheter aortic valve replacement (TAVR) can quickly stabilize patients with severe aortic stenosis and cardiogenic shock. This approach offers a viable alternative to traditional methods, leading to successful outcomes and full heart recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Severe aortic stenosis (AS) frequently leads to cardiogenic shock (CS), a critical condition with high mortality.
- Current management of AS-related CS often involves complex procedures and may have limited success.
Abstract:
A 75-year-old woman presented with severe aortic stenosis and CS (ejection fraction, 10% to 15%; lactate, 4.2 mmol/L; requiring high-dose vasopressors). During index catheterization, upfront Impella CP insertion across the stenotic valve immediately improved hemodynamics (peak-to-peak gradient reduced from 125 to 6 mm Hg). Following stabilization, staged TAVR was performed within 15 hours through the same femoral access. The patient was discharged on day 12 with complete left ventricular recovery (ejection fraction, 65% to 70%) at 6 months. This represents the first reported case of upfront Impella CP insertion during index procedure as bridge-to-TAVR without balloon aortic valvuloplasty, demonstrating feasibility and excellent outcomes in AS-related CS.
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