Key result
Impella CP-assisted left main PCI without prior valvuloplasty achieves 3-year event-free survival in critical AS.
Why the study?
The use of Impella CP is generally contraindicated in critical aortic stenosis due to risks, but emerging evidence suggests feasibility in selected patients when alternatives are limited.
Case Report (n=1)
Demonstrates the feasibility of deploying Impella CP without prior balloon aortic valvuloplasty for high-risk left main PCI as a bridge to TAVI in a patient with critical aortic stenosis, challenging the absolute manufacturer contraindication.
May support Impella in selected severe AS with limited options; challenges absolute contraindication yet leaves open need for prospective trials.
Background Severe aortic stenosis (AS) with concomitant multivessel coronary artery disease (CAD) is a high-risk clinical scenario. The Impella CP carries an absolute manufacturer contraindication in critical AS (aortic valve area [AVA] ≤0.60 cm 2 ) and is generally avoided in severe AS given risks of valve injury, acute aortic regurgitation, and device malposition. However, accumulating case-level and registry evidence supports feasibility in selected patients when alternatives are limited. Case summary An 87-year-old woman with critical AS (AVA 0.40 cm 2 , mean gradient 47 mmHg) and severe multivessel CAD, including 80% ostial left main (LM) and 70% proximal right coronary artery (RCA) stenoses, presented with acute decompensated heart failure following recent hip surgery. After Heart Team review, a staged strategy was pursued: intra-aortic balloon pump (IABP) supported RCA percutaneous coronary intervention (PCI), followed by Impella CP–assisted LM PCI without prior balloon aortic valvuloplasty (BAV) when invasive hemodynamic reassessment demonstrated insufficient reserve, and same-admission transcatheter aortic valve implantation (TAVI) with a 25 mm Navitor valve. The Impella crossed the valve in under 1 min with minimal resistance, and LM PCI was completed without hemodynamic compromise. At 3 years she remained alive, event-free, and living independently. Conclusion To our knowledge, this is the smallest AVA reported in which Impella CP was deployed without prior BAV, supporting feasibility of Impella-assisted high-risk LM PCI as a bridge to TAVI in selected patients when individualized Heart Team decision-making and a defined contingency plan are in place.
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Damera et al. (2026) conducted a case report in Critical aortic stenosis and severe multivessel coronary artery disease (n=1). Impella CP-assisted left main PCI as a bridge to TAVI was evaluated on Survival, event-free status, and independent living. Impella CP-assisted left main PCI without prior balloon aortic valvuloplasty was successful in a patient with a 0.40 cm2 aortic valve area, who remained alive and event-free at 3 years.
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