Emergency Balloon Aortic Valvuloplasty Followed by Impella Support as a Bridge to Definitive Therapy in Severe Aortic Stenosis: A Case Series

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Abstract
Objective: Severe aortic stenosis (AS) is a life-threatening valvular disease with an in-hospital mortality rate exceeding 50% when complicated by cardiogenic shock. In this critical setting, emergency balloon aortic valvuloplasty (BAV) is sometimes performed as an initial therapy. However, reports on emergency BAV followed by Impella (Abiomed, Danvers, MA, USA) support, referred to as the BAV-PELLA strategy, remain limited.Case Presentation: We report 4 patients who were treated using this strategy. This staged management markedly reduced the surgical risk scores in all 4 cases. Three of the 4 patients underwent elective definitive valve replacement after a preoperative window that provided sufficient time for hemodynamic stabilization and a comprehensive assessment of surgical candidacy. One patient required urgent surgical aortic valve replacement (SAVR) with coronary artery bypass grafting under continued combined venoarterial extracorporeal membrane oxygenation and Impella (ECPELLA) support. Among the remaining 3 patients, 1 underwent isolated SAVR, 1 underwent SAVR with mitral valve repair, and 1 underwent transcatheter aortic valve replacement (TAVR) after stabilization. Following emergent BAV, Impella placement was successfully performed in all patients, despite the persistence of severe AS. No procedure-related complications associated with BAV or Impella implantation were observed.Conclusion: The BAV-PELLA strategy not only supports circulatory recovery in the acute phase but also provides a valuable preoperative window, enabling individualized definitive therapy based on the patient’s condition.

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