Clinical applications of Impella 5.5 for acute severe bioprosthetic aortic regurgitation: a bridge to destination therapy report—case series and review

Background: Acute severe bioprosthetic aortic regurgitation complicated by cardiogenic shock represents a high-risk clinical scenario requiring urgent intervention. Conventional medical therapy is often insufficient, and options for mechanical circulatory support remain limited because severe aortic regurgitation is traditionally considered a relative contraindication to transvalvular support devices. Case summary: We describe two cases of acute severe bioprosthetic aortic regurgitation presenting with cardiogenic shock in which Impella 5.5 was utilized as temporary mechanical circulatory support to stabilize patients and facilitate definitive treatment. In the first case, Impella 5.5 support enabled successful bridge to valve-in-valve transcatheter aortic valve replacement. In the second case, Impella 5.5 was used as a bridge to redo surgical aortic valve replacement. In both cases, haemodynamic stabilization and end-organ recovery allowed progression to destination therapy. Discussion: These cases demonstrate that, in carefully selected patients with acute severe bioprosthetic aortic regurgitation and cardiogenic shock, Impella 5.5 may serve as a feasible bridge to definitive valve intervention. Although severe aortic regurgitation has traditionally limited the use of transvalvular mechanical support, these experiences suggest a potential role for Impella 5.5 in individualized management strategies. Further studies are needed to better define patient selection, safety, and outcomes.