Impact of Impella Support as a Bridge to Durable Left Ventricular Assist Device on Aortic Regurgitation Progression and Long-Term Survival

Impella support before continuous-flow left ventricular assist device (LVAD) implantation may injure the aortic valve, potentially accelerating aortic regurgitation (AR) progression, resulting in poor outcomes. A single-center retrospective analysis of 384 patients implanted with durable LVADs between 2011 and 2025 was performed. Patients were separated into prior Impella support (group 1, n = 87) and those without (group 2, n = 297). Outcomes included aortic valve intervention at LVAD implantation, AR prevalence at baseline, within 30 days, and 6 months, and mortality at 30 days and 1 year. Aortic valve intervention occurred in 10.3% of group 1 vs. 5.0% of group 2 (p = 0.071). Group 1 had higher baseline AR (24% vs. 15%, p = 0.041) and more moderate or worse AR at 30 days (3.4% vs. 0.3%, p = 0.041) and 6 months (6.8% vs. 0.6%, p = 0.014). Impella duration did not correlate with aortic valve intervention (median 8 vs. 6 days, p = 0.198). Mortality at 30 days (2% vs. 4%, p = 0.958) and 1 year (7% vs. 13%, p = 0.116) was similar. Impella use before durable LVAD was associated with increased AR progression at 30 days and 6 months. This suggests those with preoperative Impella should have the aortic valve assessed at the time of removal and consider intervention if significant.