February 15, 2020Catheterization and Cardiovascular Interventions
Impella ventricular assist device: A “valvular bypass” to support high‐risk percutaneous coronary intervention or complicated transcatheter aortic valve replacement
Key result
Impella is feasible for cardiogenic shock during TAVR, but 30-day mortality remains ~40%.
Why the study?
Severe aortic stenosis is usually considered a contraindication to Impella implantation, but its role in supporting high-risk PCI or complicated TAVR remains to be clarified.
Is the Impella ventricular assist device feasible and effective for hemodynamic support in patients with severe aortic stenosis undergoing high-risk PCI or complicated TAVR?
Population
Patients with severe aortic stenosis undergoing pre-TAVR high-risk PCI or cardiogenic shock during TAVR
Design
Review
Follow-up
30-day
Authors
Discussion
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Implication
Feasibility in TAVR shock does not justify routine use; leaves open survival benefit pending prospective trials.
Structured PICO
Is the Impella ventricular assist device feasible and effective for hemodynamic support in patients with severe aortic stenosis undergoing high-risk PCI or complicated TAVR?
P
Population
Patients with severe aortic stenosis undergoing pre-transcatheter aortic valve replacement (TAVR) high-risk percutaneous coronary intervention, or experiencing cardiogenic shock during TAVR
I
Intervention
Impella ventricular assist device
O
Outcome
Hemodynamic stabilization (reduction in left ventricular end-diastolic pressure, increase in cardiac output and coronary perfusion), feasibility, and 30-day mortality
Despite severe aortic stenosis traditionally being a contraindication, Impella may be a feasible option for hemodynamic support during pre-TAVR high-risk PCI or for cardiogenic shock complicating TAVR.
Cite This Study
Tarantini et al. (2020) conducted a review in Severe aortic stenosis, high-risk percutaneous coronary intervention, or cardiogenic shock during TAVR. Impella ventricular assist device was evaluated on 30-day mortality. Impella implantation was feasible for treating cardiogenic shock during TAVR, although 30-day mortality remained as high as 40%.