Key result
Buddy balloon technique successfully repositions a displaced Impella across a bioprosthetic aortic valve via coaxial realignment.
Why the study?
Acute Impella malposition immediately after implantation is an under-reported complication, particularly in complex post-aortic surgery anatomy, and standardized bailout strategies are lacking.
Case Report (n=1)
A fully percutaneous buddy balloon technique can serve as a successful bailout strategy for repositioning a displaced Impella across a bioprosthetic aortic valve.
Supports feasibility of bailout repositioning in complex post-aortic anatomy; leaves open standardized protocols for acute Impella malposition.
BACKGROUND: Acute Impella malposition immediately after implantation is a recognized but under-reported complication, particularly in patients with complex post-aortic surgery anatomy, and standardized bailout strategies are lacking. CASE SUMMARY: A 56-year-old man developed recurrent cardiogenic pulmonary edema and severe left ventricular (LV) dysfunction after redo aortic valve and root surgery for prosthetic valve infective endocarditis. Impella implantation was performed for hemodynamic deterioration, but the device displaced from the LV into the ascending aorta during removal of the peel-away sheath. A fully percutaneous "buddy balloon" technique, using a low-pressure balloon across the bioprosthetic aortic valve, enabled coaxial realignment and successful repositioning into the LV. DISCUSSION: Acute Impella displacement requiring advanced bailout strategies is rarely described. To our knowledge, this is the first report of a fully percutaneous balloon-assisted technique in this setting, which may represent a novel strategy requiring further validation.
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Casula et al. (2026) conducted a case report in Acute Impella malposition (n=1). Buddy balloon-assisted repositioning was evaluated on Successful repositioning into the left ventricle. A fully percutaneous buddy balloon technique enabled coaxial realignment and successful repositioning of a displaced transvalvular Impella across a bioprosthetic aortic valve into the left ventricle.
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