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.