JACC Case Rep. 2026 May 15:108333. doi: 10.1016/j.jaccas.2026.108333. Online ahead of print.
ABSTRACT
BACKGROUND: Acute Impella malposition immediately after implantation is a recognized but under-reported complication, particularly in patients with complex post-aortic surgery anatomy, and standardized bailout strategies are lacking.
CASE SUMMARY: A 56-year-old man developed recurrent cardiogenic pulmonary edema and severe left ventricular (LV) dysfunction after redo aortic valve and root surgery for prosthetic valve infective endocarditis. Impella implantation was performed for hemodynamic deterioration, but the device displaced from the LV into the ascending aorta during removal of the peel-away sheath. A fully percutaneous "buddy balloon" technique, using a low-pressure balloon across the bioprosthetic aortic valve, enabled coaxial realignment and successful repositioning into the LV.
DISCUSSION: Acute Impella displacement requiring advanced bailout strategies is rarely described. To our knowledge, this is the first report of a fully percutaneous balloon-assisted technique in this setting, which may represent a novel strategy requiring further validation.
PMID:42142101 | DOI:10.1016/j.jaccas.2026.108333