The Journal of invasive cardiology
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Case Reports
Bail-Out Use of Impella CP as a Bridge to TAVI in a Cardiogenic Shock Patient: The "Pump-Rewiring" Technique.
The optimal management of cardiogenic shock (CS) occurring in the presence of acute coronary syndromes, severe aortic stenosis, and poor left ventricular function has not been established. Recently, the availability of new assistance devices and techniques has provided novel management opportunities. In particular, when compared with surgical approaches, percutaneous procedures have the advantage of allowing "staged" interventions, in which different steps are planned according to the patient's evolving clinical conditions. ⋯ This case example demonstrates how a tailored step-by-step strategy including PCI, BAV, peripheral angioplasty, percutaneous ventricular assistance, and transcatheter aortic valve implantation (TAVI) allowed the successful treatment of a critical patient with CS. Impella CP could be considered an effective bridge to TAVI in patients developing aortic regurgitation after BAV, since maintaining arterial access can be achieved using the pump-rewiring technique.