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High-risk patients with reduced ejection fraction (EF) and severe symptomatic aortic stenosis (AS) might require extra-hemodynamic support to unload the ventricle and to allow for a decrease end-diastolic wall stress therefore improvement of diastolic compliance. This can facilitate those patients to successfully undergo percutaneous aortic valvuloplasty (BAV). Data in regards the use of Impella support is scarce and limited to only report of case-series. We aimed to investigate the clinical outcomes of Impella use in high-risk patient with severe symptomatic AS.
Pub Med, Chochrane and Embase were systematically searched for all available clinical data reporting hemodynamic support with Impella in high-risk patients with severe AS undergoing percutaneous BAV. We reported sex, mean age, baseline EF, aortic valve area (AVA), previous CABG and clinical outcomes including periprocedural death, AMI, stroke and duration of Impella use. For constant variable we described as mean and standard deviation.
A total of 6 reports provided a total of 38 patients. Mean age was 80.7±5.21 years, majority of patients were men (81.7%), mean baseline EF 17.42%±0.4 and mean AVA 0.63±0.14 cm2. There were a total 2 deaths (5.2%). Only 5 authors reported AMI and stroke outcomes; all them reported zero events. More than 95% of the time, Impella device was used for less than 24 hours.
Our analysis suggests that Impella use during high-risk percutaneous BAV can lead to good outcomes and low mortality rate. This can temporarily improve clinical status of severe symptomatic patients serving as a bridge for definitive valve replacement. Clinical efficacy should be further studied in randomized studies.