Acute valvular emergencies are common causes of cardiogenic shock. Patients with critical aortic pathologies causing shock frequently undergo percutaneous interventions for valve replacement. However, in cases of persistent cardiogenic shock after valve replacement, there are limited options for further mechanical support. In this case study, we report a patient with a prior history of aortic valve replacement who presented in cardiogenic shock. After a transcatheter aortic valve-in-valve replacement, he remained in persistent shock with worsening clinical parameters requiring escalating inotropic and vasopressor support. With input from a multidisciplinary care team, an Impella 5.5 (Abiomed, Inc.) was placed through the valve for mechanical circulatory support, ultimately serving as a bridge to a durable left ventricular assist device as destination therapy. This technically challenging approach was successful, and the patient was discharged to acute rehabilitation with improved symptoms.
Kieserman, Jake; Wald, Joyce; Sheehan, Megan; Cevasco, Marisa; McCauley, Brian; Prentice, Ryan; and Giri, Jay
"The Brink of the Abyss: From Transcatheter Aortic Valve Implantation, to Impella, to Left Ventricular Assist Device Destination Therapy,"
Journal of Shock and Hemodynamics: Vol. 2(1)
Available at: https://digitalcommons.library.tmc.edu/josh/vol2/iss1/2