Upfront Impella CP as Bridge-to-Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis and Cardiogenic Shock: Case Report

TL;DR

A 75-year-old woman with severe heart valve disease and shock was successfully treated using a novel approach involving an Impella CP device and valve replacement.

Contribution

This is the first reported case of upfront Impella CP insertion as a bridge to transcatheter aortic valve replacement without balloon valvuloplasty.

Findings

Upfront Impella CP insertion significantly improved hemodynamics in a patient with severe aortic stenosis and cardiogenic shock.

Staged transcatheter aortic valve replacement was successfully performed within 15 hours of Impella CP insertion.

The patient showed complete left ventricular recovery within six months after treatment.

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.

Figures