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.