Feasibility and Safety of Impella-Assisted High-Risk PCI Before TAVR in Patients With Severe Aortic Stenosis

Ilhwan Yeo; Shing-Chiu Wong; Charles A Mack; Willis Ko; Luke K Kim; Dmitriy N Feldman; Mark Reisman; Stephanie L Mick; Erin M Iannacone; Tara Shah; Geoffrey Bergman; Robert M Minutello

doi:10.1016/j.jscai.2023.101061

Feasibility and Safety of Impella-Assisted High-Risk PCI Before TAVR in Patients With Severe Aortic Stenosis

J Soc Cardiovasc Angiogr Interv. 2023 Jun 29;2(5):101061. doi: 10.1016/j.jscai.2023.101061. eCollection 2023 Sep-Oct.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, Weill Cornell Medicine-NewYork-Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group, New York, New York.
² Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
³ Division of Cardiology, Department of Medicine, NewYork-Presbyterian Queens, Flushing, New York.

Abstract

Background: There are limited data on the feasibility of Impella-assisted percutaneous coronary intervention (PCI) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Methods: To assess the feasibility of the Impella-assisted PCI in patients with severe symptomatic AS, we retrospectively reviewed the medical records to identify patients who were electively admitted for Impella-assisted PCI with a subsequent TAVR at Weill Cornell Medical Center from 2016 to 2021.

Results: During the study period, 15 patients were identified to be eligible for the study, but the Impella failed to cross the aortic valve in 1 patient despite a concomitant balloon aortic valvuloplasty requiring a switch to an intra-aortic balloon pump to assist PCI. A total of 14 patients underwent successful PCI with the Impella CP and were included in the analysis. The median age was 89 years, and women accounted for 43% of the cohort. The median aortic valve area and mean gradient were 0.85 cm² and 40 mm Hg, respectively, with a median left ventricular ejection fraction of 51%. The median SYNTAX score was 13. The left main stent was placed in 6 patients (43%), with a rotational atherectomy performed in 10 patients (71%). The balloon aortic valvuloplasty was performed in 2 patients before Impella placement. The TAVR was performed in all 14 patients on a median post-Impella-assisted PCI day of 25. No procedural complications were noted post-TAVR with no in-hospital or 30-day death.

Conclusions: In this single-center study of patients with severe AS, the elective Impella-assisted high-risk PCI was feasible and safe before TAVR in selected patients.

Keywords: Impella-assisted percutaneous coronary intervention; obstructive coronary artery disease; severe symptomatic aortic stenosis; transcatheter aortic valve replacement.