Impella-Assisted Balloon Aortic Valvuloplasty as a Bridge to Transcatheter Aortic Valve Replacement: Non-Contrast Approach

摘要

Patients with severe aortic stenosis (AS) and left ventricular dysfunction are susceptible to hemodynamic decompensation due to limited myocardial reserve. Recent reports have suggested a role for hemodynamic assist devices such as the Impella or TandemHeart for improved in-hospital outcomes. However, the use of iodinated contrast during this vulnerable period poses a high risk for the development of contrast-induced nephropathy. A strategic approach is described for the treatment of high-risk patients with severe AS and cardiogenic shock, utilizing Impella-assisted balloon aortic valvuloplasty (BAV), without the administration of iodinated contrast as a bridge to transcatheter aortic valve replacement.