# Impella-Supported Off-Pump Coronary Artery Bypass Grafting (CABG) in a Patient With Severe Mitral Regurgitation: A Case Report

## TL;DR

A patient with heart issues experienced complications during surgery when a support device shifted, causing severe valve problems.

## Contribution

Highlights a rare complication of Impella use during off-pump CABG and suggests alternative circulatory support methods.

## Key findings

- Impella device shifted during surgery, interfering with the mitral valve and causing severe regurgitation.
- Alternative circulatory support methods should be considered in patients with small left ventricles.
- Heart teams should be cautious about mitral valve interference during Impella decannulation.

## Abstract

Perioperative cardiogenic shock can be fatal, and assisted circulation with an Impella percutaneous ventricular support pump catheter (Abiomed, Danvers, MA, USA) is useful in patients with severely compromised cardiac function. However, we report a case in which an Impella implanted preoperatively deepened its position during off-pump coronary artery bypass grafting decannulation. This change in position caused the Impella to interfere with the posterior mitral valve leaflet and led to severe mitral regurgitation and difficulty with intraoperative circulatory control. In patients without significant left ventricular enlargement, the heart team should discuss the risk of interference with the mitral valve and inhalation failure during decannulation. In such cases, other forms of assisted circulation, such as intra-aortic balloon pumping or cardiopulmonary bypass, should be considered.