Dramatic Bridge to Bridge Response Using the Impella 5.0 Device

Abstract

Percutaneous left ventricular assist devices are approved for cardiogenic shock, but there has been increasing interest in utilizing these devices for hemodynamic support as bridge to durable mechanical circulatory support (MCS). A 63 year-old male with severe ischemic cardiomyopathy was evaluated for MCS. Given severe MR at baseline, it was felt that the Impella 5.0 device would offer the best hemodynamic optimization. Transesophageal echocardiography (TEE) showed severely enlarged left ventricle (78mm) and severe MR (effective regurgitant orifice (ERO) of 0.65cm2 and regurgitant volume (RV) of 94ml. After introduction of an Impella with TEE demonstrating correct placement, mean wedge pressure fell to 11 mmHg, lacking prominent V-waves. The severity of MR decreased to mild-moderate (ERO 0.17cm2 and RV 30 ml). He underwent LVAD implant after five days of support. This case highlights the acute hemodynamic improvements observed after implantation of an Impella 5.0 in a patient with severe ischemic cardiomyopathy and functional mitral regurgitation, illustrating the benefit of percutaneous devices as bridge to durable MCS, especially in the setting of coexistent valvular disease.