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

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic stenosis and cardiogenic shock (n=1). Intervention: Upfront Impella CP insertion followed by TAVR. Primary outcome: Feasibility and clinical outcome (left ventricular recovery).

Q: What does this research mean for the field?

Upfront Impella CP insertion as a bridge to TAVR without balloon aortic valvuloplasty is feasible in severe aortic stenosis and cardiogenic shock, significantly reducing peak-to-peak gradients and enabling complete left ventricular recovery. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

D. Garín; Benjamin Assouline; Sophie Degrauwe; Juan F. Iglesias

doi:10.1016/j.jscai.2025.103924

September 17, 2025Journal of the Society for Cardiovascular Angiography & InterventionsOpen Access

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

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Key result

Upfront Impella CP without valvuloplasty successfully bridges cardiogenic shock to TAVR with complete LV recovery.

n=1

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Why the study?

Does upfront Impella CP insertion without balloon aortic valvuloplasty improve hemodynamics and provide an effective bridge to TAVR in severe aortic stenosis complicated by cardiogenic shock?

Key Points

To report the feasibility and clinical efficacy of upfront Impella CP insertion during index catheterization without balloon aortic valvuloplasty as a bridge to transcatheter aortic valve replacement in severe aortic stenosis complicated by cardiogenic shock.
A 75-year-old woman presented with severe aortic stenosis (valve area, 0.57 cm2) and profound cardiogenic shock (ejection fraction, 10% to 15%; lactate, 4.2 mmol/L) requiring mechanical ventilation and high-dose vasopressor support.
An Impella CP microaxial flow pump was inserted via 14F right femoral access across the stenotic valve at performance level P8 (3.8 L/min flow rate) during index catheterization without preceding balloon aortic valvuloplasty.
Following 15 hours of hemodynamic stabilization, the Impella CP was removed, and staged transcatheter aortic valve replacement with a 29.0-mm Evolut PRO+ was completed via the same femoral access.
Upfront Impella CP insertion immediately unloaded the left ventricle, reducing the peak-to-peak aortic gradient from 125 to 6 mm Hg and enabling progressive weaning of vasopressors.
Following staged valve deployment, postdeployment hemodynamics demonstrated a residual peak-to-peak gradient of 10 mm Hg with no significant paravalvular leak, permitting extubation within 24 hours and discharge on day 12.
At 6-month follow-up, the patient achieved complete left ventricular recovery with an ejection fraction of 65% to 70% and normal prosthetic valve function.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does upfront Impella CP insertion without balloon aortic valvuloplasty improve hemodynamics and provide an effective bridge to TAVR in severe aortic stenosis complicated by cardiogenic shock?

P

Population

A 75-year-old woman with severe aortic stenosis and cardiogenic shock requiring high-dose vasopressors, followed for 6 months.

I

Intervention

Upfront Impella CP microaxial flow pump insertion across the stenotic valve without balloon aortic valvuloplasty during index catheterization, serving as a bridge to definitive staged TAVR within 15 hours.

O

Outcome

Feasibility of bridge-to-TAVR, hemodynamic improvement, and left ventricular recovery at 6 monthssurrogate

This case demonstrates the feasibility of using an upfront Impella CP without balloon aortic valvuloplasty as a primary bridge strategy for TAVR in patients with severe aortic stenosis and cardiogenic shock.

Limitations

Single case report requires validation in larger series
Patient selection remains crucial, including valve anatomy and absence of significant coronary disease
Ability to insert Impella without BAV despite severe stenosis may not be replicable in all cases
Using the same vascular access raises potential infection concerns
Crossing severely stenotic valve without BAV may not be replicable in all cases
Using same vascular access raises potential infection concerns

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Implication

May support upfront Impella CP without BAV as bridge to TAVR in select AS shock cases; leaves open efficacy in prospective cohorts.

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.

Discussion

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Cite This Study

Garín et al. (2025) conducted a case report in Severe aortic stenosis and cardiogenic shock (n=1). Upfront Impella CP insertion followed by TAVR was evaluated on Feasibility and clinical outcome (left ventricular recovery). Upfront Impella CP insertion without balloon aortic valvuloplasty successfully bridged the patient to TAVR, resulting in immediate hemodynamic improvement and complete left ventricular recovery (EF 65%-70%) at 6 months.

synapsesocial.com/papers/6a155bb6a4734e8e604e3c1f https://doi.org/10.1016/j.jscai.2025.103924

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

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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