INTRODUCTION
Despite clear clinical benefits, there is limited evidence regarding
possible complications relating to the Impella (Abiomed Inc., Danvers,
Massachusetts) mechanical support device. The Impella device is being
increasingly used as an alternative to the intra-aortic balloon pump
(IABP) and veno-arterial extracorporeal membrane oxygenation (VA ECMO)
for haemodynamic support in patients with cardiogenic shock and
high-risk percutaneous coronary intervention [1]. It can also
effectively vent the left ventricle, especially in the setting of
incomplete unloading of the left ventricle during VA ECMO support
[2-5]. Furthermore, several percutaneous mechanical circulatory
support devices (VA ECMO, CentriMag, TandemHeart) including Impella have
been introduced into clinical practice for bridging patients with
end-stage heart failure to recovery, durable left ventricular assist
device support or orthotopic heart transplantation [6, 7]. Placement
and use of the Impella device bear potential risks. To date,
complications that have been reported are device-related, peripheral
vascular, distal thrombus formation with subsequent strokes, and
valvular injuries. The objective of this article is to draw specific
attention to valvular injuries as potential periprocedural complications
during Impella device support.