Microaxial Flow Pump–Protected Percutaneous Pulmonary Valve Replacement in High-Risk Patients With Severe Left Ventricular Dysfunction

Percutaneous pulmonary valve replacement is a safe and effective minimally invasive strategy for patients with pulmonary valve dysfunction. Ventricular dysfunction may pose a risk for acute heart failure due to the immediate hemodynamic changes induced by revalvulation. In this case series, we describe the periprocedural use of a percutaneous left ventricular assist device (Impella CP) to prevent hemodynamic decompensation during pulmonary valve replacement. Three patients (aged 45-63 years) with repaired congenital heart disease underwent percutaneous implantation of the Impella CP assist device concomitant to transcatheter pulmonary valve replacement with the self-expandable Venus P-Valve. Beyond severe pulmonary valve regurgitation and right ventricular dilatation, they had severely compromised systolic and/or diastolic biventricular function. Valve replacement was uneventful. Patients were weaned off circulatory support 1 to 3 days after the procedure. During follow-up, clinical status and biventricular function improved. Periprocedural mechanic circulatory support using the Impella CP can successfully facilitate transcatheter pulmonary valve replacement in high-risk patients.