title: Percutaneous retrograde left ventricular assist support for interventions in patients with aortic stenosis and left ventricular dysfunction.
abstract: OBJECTIVE
  To evaluate feasibility and technical outcomes in patients with aortic stenosis (AS) who have undergone high-risk procedures with continuous flow left ventricular (LV) assist, with the Impella 2.5 system (Abiomed, Danvers, MA).
  
  
  BACKGROUND
  In preparation for transcatheter aortic valve implantation, an increasing number of high-risk patients with severe AS and left ventricular dysfunction are currently considered for percutaneous coronary interventions (PCI) and balloon aortic valvuloplasty (BAV). Hemodynamic support may be required in some patients.
  
  
  METHODS
  We reviewed procedural and clinical findings and 30-day outcomes in patients with symptomatic AS who underwent high-risk percutaneous procedures supported by the Impella 2.5 system. All patients carried a high-risk of operative mortality. Impella was used during PCI, BAV, and for hemodynamic support during emergencies.
  
  
  RESULTS
  Over a 14-month period, 21 patients with AS underwent insertion of Impella prior to high-risk PCI (n = 3), BAV with subsequent PCI (n = 8), BAV alone (n = 7), or during cardiac arrest immediately following BAV (n = 3). The mean Society of Thoracic Surgeons (STS) predicted mortality risk was 14% (range 7.3-24.7%). Impella was inserted successfully in all patients attempted. Retrograde advancement of two catheters across the aortic valve (for concomitant BAV in 15 patients) was technically feasible. Retrograde continuous flow LV assist produced a reduction in LV end-diastolic pressure and an increase in arterial pressure. Periprocedural complications occurred in 19% (n = 4) patients, with no periprocedural deaths. Mortality at 30 days was 14.2%.
  
  
  CONCLUSIONS
  Our data suggests that continuous flow LV assist with Impella 2.5 can be used in high-risk patients with severe AS who require periprocedural hemodynamic support.
authors.affiliation: Cardiovascular Division, and Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, Miami, Florida, USA. cmartinez5@med.miami.edu
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Martinez
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Juan C
authors.initials: JC
authors.lastname: Londoño
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006353:Heart-Assist Devices; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016277:Ventricular Function, Left; D017725:Ventricular Pressure