Use of Impella Support in Transcatheter Aortic Valve Replacement for a Patient With Severe Aortic Stenosis and Significantly Reduced Ejection Fraction.

Abstract Transcatheter aortic valve replacement (TAVR) may be complicated by hemodynamic instability or circulatory collapse, especially in patients with severe left ventricular dysfunction. The Impella is a catheter-based ventricular assist device that is used in cardiogenic shock after myocardial infarction, high-risk percutaneous coronary intervention, and medically refractory heart failure. However, there is not a well-defined role for Impella in high-risk TAVR procedures. In this report, we describe the case of a patient with very low left ventricular ejection fraction undergoing TAVR with provisional Impella bailout use in the event of cardiovascular collapse during the procedure.