Valvular Complications Related to Microaxial Assist Device Use: A Case-Level Systematic Review

Microaxial devices provide effective short-term hemodynamic support in patients with cardiogenic shock or during high-risk procedures. However, there is a paucity of data regarding device-associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes.

An electronic search was conducted in October 2024 to identify studies reporting microaxial device-associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient-level data were extracted for analysis.

The median age was 50 years [IQR 34-65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high-risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3-15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In-hospital/30-day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre-existing bioprosthetic aortic valve (p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow-up of 183 [30-365] days, overall survival was 89% (24/27).

AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury.