The Fate of the Aortic Valve after Implantation of Abiomed Impella-Device in Heart-Failure Patients Bridged to Permanent LVAD. Is There a Risk for Aortic Regurgitation in the Long Term?

Objectives: Patients in cardiogenic shock are more frequently treated with the Abiomed Impella Device (AID) for unloading the left ventricle and to ensure a system flow in severe left ventricle dysfunction as a temporary mechanical circulatory support (MCS). However, there is a risk for damaging the aortic valve during the insertion. This new valve pathology may have hemodynamic consequences for patients who are directly bridged to a permanent LVAD in the long term.

Methods: We retrospectively describe a small series (n = 15) of heart failure patients treated with AID with or without VA-ECMO who have been directly bridged to a permanent LVAD between 2014 and 2018. Before percutaneous insertion, all patients underwent a transesophageal echocardiography to evaluate heart function and to detect valve pathologies. After LVAD implantation, all patients were followed up regularly in the outpatient clinic. Echocardiography investigations were available for at least 12 months after LVAD implantation for these patients.

Results: Out of 15 patients, 13 had no aortic valve pathology (NAVP). The remaining two patients had before AID implantation already a mild aortic regurgitation (AVP). From the NAVP group, seven patients developed within 12 months a mild to moderate aortic regurgitation (54%) after LVAD implantation. There was no change observed in AVP group regarding the aortic valve pathology. Furthermore, 11 had peripheral VA-ECMO for treating the acute heart failure and 1 patient died due to cranial hemorrhage after LVAD implantation.

Conclusion: The Abiomed Impella as temporary MCS has emerged as therapeutic option in the management of heart failure patients, especially in bridging patients to a permanent LVAD. However, the insertion of AID might cause an undetected aortic pathology, which leads in the long term in LVAD patients to an aortic regurgitation with hemodynamic consequences. Further studies are needed to evaluate our results.