Emergency Balloon Aortic Valvuloplasty Followed by Impella Support as a Bridge to Definitive Therapy in Severe Aortic Stenosis: A Case Series

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic stenosis complicated by cardiogenic shock (n=4). Intervention: Emergency balloon aortic valvuloplasty followed by Impella support (BAV-PELLA strategy). Primary outcome: Successful transition to definitive valve replacement therapy.

Yufuko Nishida; Tetsuya Matsuyama; Yosuke Miyazaki; Tetsuro Oda; Keita Kaneyuki; Tatsuhiro Fujimura; Takeshi Suetomi; Takuma Nanno; Yasutake Yano; Yuki Nakata; Takayuki Okamura; Motoaki Sano

doi:10.33290/jtvt.cr.26-0013

January 1, 2026Journal of Transcatheter Valve TherapiesOpen Access

Emergency Balloon Aortic Valvuloplasty Followed by Impella Support as a Bridge to Definitive Therapy in Severe Aortic Stenosis: A Case Series

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Why the study?

Emergency balloon aortic valvuloplasty followed by Impella support as a bridge to definitive therapy in severe aortic stenosis complicated by cardiogenic shock has limited reports.

Key Points

To describe the utility and hemodynamic outcomes of emergency balloon aortic valvuloplasty followed by Impella mechanical circulatory support (the BAV-PELLA strategy) as a bridge to definitive therapy in patients with severe aortic stenosis complicated by cardiogenic shock.
Evaluated patients with severe aortic stenosis presenting with cardiogenic shock who underwent emergency balloon aortic valvuloplasty (BAV) using Inoue balloons.
Applied mechanical circulatory support via Impella CP or combination ECPELLA (V-A ECMO plus Impella CP) to facilitate left ventricular unloading and hemodynamic recovery prior to definitive intervention.
In an initial case, emergency BAV reduced the mean transaortic pressure gradient from 56 to 34 mmHg and increased aortic valve area from 0.34 to 0.46 cm², with the STS risk score decreasing from 13.8% to 7.8% before surgical repair.
In a hemodialysis-dependent patient in cardiogenic shock, ECPELLA support improved serum lactate from 5.9 mmol/L to approximately 1 mmol/L and reduced the STS score from 54.5% to 31.3%, allowing definitive surgery on day 4.

Study Design

Type

Case Report (n=4)

Multicenter

No

Structured PICO

P

Population

4 patients aged 62 to 91 with severe aortic stenosis complicated by cardiogenic shock treated with emergency balloon aortic valvuloplasty followed by Impella support as a bridge to definitive therapy.

I

Intervention

Emergency balloon aortic valvuloplasty (BAV) followed by percutaneous microaxial flow pump (Impella) support (BAV-PELLA strategy) as a bridge to definitive therapy

O

Outcome

Feasibility, circulatory recovery, reduction in surgical risk score, and successful bridge to definitive valve replacement

The BAV-PELLA strategy is a feasible and potentially life-saving bridge to definitive therapy for patients with severe aortic stenosis complicated by cardiogenic shock.

Limitations

Small number of patients from a single center
Long-term outcomes were not assessed
Generalizability of the strategy remains uncertain

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Implication

Supports feasibility of BAV-PELLA bridging in select AS shock cases; hypothesis-generating and requires prospective validation before practice change.

Abstract

Objective: Severe aortic stenosis (AS) is a life-threatening valvular disease with an in-hospital mortality rate exceeding 50% when complicated by cardiogenic shock. In this critical setting, emergency balloon aortic valvuloplasty (BAV) is sometimes performed as an initial therapy. However, reports on emergency BAV followed by Impella (Abiomed, Danvers, MA, USA) support, referred to as the BAV-PELLA strategy, remain limited.

Discussion

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Cite This Study

Nishida et al. (2026) conducted a case report in Severe aortic stenosis complicated by cardiogenic shock (n=4). Emergency balloon aortic valvuloplasty followed by Impella support (BAV-PELLA strategy) was evaluated on Successful transition to definitive valve replacement therapy.

synapsesocial.com/papers/6ac835407c3139e1cb0e7d43 https://doi.org/10.33290/jtvt.cr.26-0013

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Emergency Balloon Aortic Valvuloplasty Followed by Impella Support as a Bridge to Definitive Therapy in Severe Aortic Stenosis: A Case Series

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Emergency Balloon Aortic Valvuloplasty Followed by Impella Support as a Bridge to Definitive Therapy in Severe Aortic Stenosis: A Case Series

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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