Mitral valve regurgitation or injury
There have been several reports of acute severe mitral regurgitation (MR) caused by iatrogenic injury of the mitral valve apparatus related to the Impella, in particular due to chordal rupture [19-22]. A possible mechanism of chordae tendineae injury during the initial positioning of the Impella across the aortic valve is from mechanical damage from either guidewire, or the Impella device [21]. If not diagnosed, acute severe MR may lead to rapid decompensation after Impella removal, therefore, prompt diagnosis is of paramount importance [19]. If there is extensive damage of the mitral valve apparatus, mitral valve repair or replacement may be required. However, surgical treatment might not be successful despite supportive measures, due to the severity of complications in combination with the underlying clinical condition [22].
There are several limitations to this study. Firstly, available literature about complications related to Impella remains limited. Data are derived from case reports and observational retrospective studies. Furthermore, there is a lack of follow-up and detailed description of mechanisms of valve injury in some of the reports.