Impella 5.5 Use in the Setting of Severe Aortic Insufficiency: A Relative Contraindication

Moderate or severe aortic insufficiency is a contraindication to transvalvular Impella due to concern for worsening valvular insufficiency and recirculation.We report the case of a 75-year-old man with severe eccentric aortic insufficiency and systemic hypoperfusion who was supported with transvalvular Impella 5.5 for 6 days as preoperative rehabilitation prior to aortic valve replacement.Impella provided adequate systemic tissue perfusion while left ventricular function remained without signs of volume overload and recirculation.Moderate or severe aortic insufficiency may not be an absolute contraindication to transvalvular Impella, although this is case-dependent.