Associazione Nazionale Medici Cardiologi Ospedalieri



Iatrogenic Acute Mitral Insufficiency Following Impella-Assisted Interventional Procedure

Totaro Pasquale Pavia(Pavia) – SC Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo | Pelenghi Stefano Pavia(Pavia) – SC Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo


Short-term left ventricle mechanical assistance device could be useful in assist interventional cardiologist during high-risk procedures. Abiomed Impella is one of the most frequently used device in this respect due to the high flow available with a low rate of reported complications. Here we report a rare but potentially catastrophic complication related to the Impella device.

Case description

A 78 years old patient was referred to our Division by a peripheral hospital for a severe, symptomatic (NYHA III) mitral regurgitation (MR) due to posterior mitral leaflet prolapse (with focal eversion of P3) and chordal rupture (Fig 1a). Medical history included a previous admission in the some hospital due to a scheduled Impella-assisted PTCA (left main/left anterior descending artery) . Pre-procedural trans-thoracic ECHO (TTE) did not show significant MR (Fig 1b).


Patient underwent urgent surgical procedure. At operation postero-medial mitral commissure was seen to be completely everted with multiple rupture of P3 and A3 chordae. Surgical procedure (Fig 1c) included: P3 plication + posterior-medial commissure edge-to-edge plasty + complete mitral semi-rigid ring (Simulus) n.30. Left atrial appendage was also closed using an external Atriclip. Postoperative course was without significant complications except a superficial wound dehiscence which delayed hospital discharge till 20th postoperative day.


Despite being a feasible and attractive option for short-term mechanical circulation assistance during high-risk interventional procedure, Impella device insertion could cause significant mitral valve damage leading to clinical deterioration. Such potentially catastrophic complication should be, therefore, mandatory excluded before patient discharge following interventional procedure.