From the Guidelines
Absolute contraindications for Impella placement include left ventricular thrombus, aortic stenosis, peripheral artery disease, or aortic disease, as these conditions may physically prevent proper positioning, increase risk of device failure, or could lead to catastrophic complications. According to the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization 1, the use of the Impella support devices is limited in patients with these conditions.
Key Contraindications
- Left ventricular thrombus
- Aortic stenosis
- Peripheral artery disease
- Aortic disease These contraindications are crucial to consider before Impella placement to avoid potential complications. It is essential to conduct a comprehensive assessment, including echocardiography and vascular imaging, to rule out these contraindications before proceeding with Impella placement. The device requires adequate peripheral vascular access for safe insertion, and any conditions that may compromise this access or increase the risk of device failure should be carefully evaluated.
From the Research
Absolute Contraindications of Impella
- There are no absolute contraindications of Impella explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, moderate or severe aortic insufficiency is considered a contraindication to transvalvular Impella left ventricular assist device use, although this may not be an absolute contraindication in all cases 3.
- The use of Impella may increase the risk of de novo aortic insufficiency post left ventricular assist device implantation 4.
- Severe aortic stenosis was once considered a relative contraindication, but the use of Impella in this setting has been proven feasible and demonstrated promising results in selected high-risk patients 2.