Original ArticlePeriprocedural Dynamics of Aortic Regurgitation in Patients Supported with an Impella® Left Ventricular Assist Device

Abstract Objectives To determine the presence and the periprocedural changes of aortic regurgitation (AR) in patients supported with an Impella® LVAD. Design Retrospective analysis of patient electronic medical records. Setting Tertiary academic medical center. Population Patients who underwent insertion of Impella® device at Allegheny General Hospital from January 2015 to December 2018. Measurements Demographic information, comorbidities, duration of support, and the presence and severity of AR pre- and post-procedure, as reported by echocardiography. Main Results Electronic medical records of 69 patients were included in this analysis. Before placement of Impella®, 25 (35%) patients showed detectable AR: 18 (26%) showed mild AR, and 7 (10%) showed moderate AR. After the removal of Impella®, AR remained steady or increased in 61 patients. 15 patients (22%) demonstrated mild AR, 6 (8.7%) demonstrated moderate AR, and 2 (2.9%) demonstrated severe AR. An increase in severity of AR was noted in 9 patients (14.7%); 52 patients (85%) had no change in the severity of AR. The duration of the support with Impella®, demographic variables and comorbidities were not associated with a statistically significant risk for the increased severity of post-procedural AR in multiple multivariable logistic regression analyses. Conclusions The presented data suggest that following Impella® support, a significant proportion of patients may show evidence of increased AR. Further studies are needed to understand the etiology and significance of this observation.