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.