# 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.

## Key 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.