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Impella 5.0 repositioning across the aortic valve without a guidewire using rapid ventricular pacing: A case report
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  • Paolo Masiello,
  • Francesco Frunzo,
  • Marco Padula,
  • Generoso Mastrogiovanni,
  • Donato Triggiani,
  • Alessandro Laudani,
  • Rocco Leone,
  • Severino Iesu
Paolo Masiello
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Francesco Frunzo
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Marco Padula
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Generoso Mastrogiovanni
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Donato Triggiani
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Alessandro Laudani
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Rocco Leone
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Severino Iesu
University Hospital 'San Giovanni di Dio e Ruggi d’Aragona'
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Abstract

Background Displacement of Impella 5.0 secondary to patient movement or transportation is a well known complication. Typically, repositioning of an Impella across the aortic valve is attempted over a guidewire. We present the first case, to our knowledge, of repositioning a dislodged Impella 5.0 without a guidewire under transesophageal echocardiography (TEE) guidance, by inducing rapid ventricular pacing to cross the aortic valve. Case presentation: A 70-year-old man with low left ventricular ejection fraction underwent off-pump coronary artery bypass grafting (OPCABG). On 2nd postoperative day a low cardiac output state developed with increasing lactate levels and consequently the patient was taken to the cardiac catheterization laboratory for insertion of an Impella 5.0. Suddenly the Impella system failed with a rapid hemodynamic deterioration and it was successfully bedside repositioned inducing rapid ventricular pacing. Conclusions: In case of accidental Impella dislodgement and fast deterioration of patient’s hemodynamic status, rapid pacing may be an option to “open” the aortic valve thus aiding quick replacement of Impella 5.0 through the aortic valve into the left ventricle under TEE guidance.

Peer review status:ACCEPTED

27 Apr 2020Submitted to Journal of Cardiac Surgery
29 Apr 2020Assigned to Editor
29 Apr 2020Submission Checks Completed
29 Apr 2020Reviewer(s) Assigned
23 May 2020Review(s) Completed, Editorial Evaluation Pending
23 May 2020Editorial Decision: Accept