CONCLUSION
This present study contributes to the emerging evidence about rare but
potentially life-threatening complications related to the Impella
device, emphasising the need for careful management and meticulous
follow-up of these patients so as to recognise complications early and
prevent potentially devastating complications. In order to reduce the
risk of these complications, our recommendation would be to use
continuous echocardiographic and/or fluoroscopy guidance during Impella
implantation. Furthermore, device repositioning or removal should be
always performed under echocardiographic guidance. Optimal placement of
the Impella device should be accomplished by positioning the inlet
approximately 3.5cm from the aortic valve annulus (in a normal
ventricular cavity) and avoiding displacement towards the mitral valve
leaflets [23]. Special care must be taken that the Impella catheter
is properly fixed and secured to avoid any dislodgment. This includes
documentation of the exact position. In our opinion, it is very
important that the flow is either stopped or nearly completely reduced
before either repositioning or removal of the Impella to avoid any
leaflet damage related to the effect of suction. Further prospective
studies with long-term follow-up are still needed.
Author contributions: DS : Conceptualization; Formal analysis;
Investigation; Methodology; Writing - Original Draft; Writing - Review
& Editing. TK, NJL, US , Conceptualization, Investigation;
Methodology; Writing - Review & Editing.