Case Report: Management of Refractory Cardiogenic Shock with Impella 5.5 in Patients with Transcatheter Aortic Valves

Abstract Background Impella is a trans-aortic valvular pump commonly utilized in patients with cardiogenic shock. However, its use transcatheter aortic valves (TAVI) remains rare. We present two cases where surgical 5.5 was placed across both Sapien 3 Ultra and Evolute Pro+ valves. Case Summary Patient 1: 74-year-old male history of ischemic cardiomyopathy ejection fraction 20-25% status post cardiac resynchronization therapy defibrillator, severe stenosis (AS) recent TAVI presented Due to persistent unstable hemodynamic status, as bridge left ventricular assist device. 2: alcoholic cirrhosis AS underwent at outside facility. The implantation complicated by main coronary artery occlusion, leading required femoral veno-arterial ECMO support emergent single vessel bypass saphenous venous graft the anterior descending artery. decannulated on day 20 recovery. In cases, there were no procedural complications or residual perivalvular regurgitation. Discussion implanted via axillary cutdown safe feasible approach manage refractory shock including different types valves, Pro+. As it can provide full support, be used recovery durable mechanical support.