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Valvular Complications Related to Microaxial Assist Device Use: A Case‐Level Systematic Review
Journal article   Open access   Peer reviewed

Valvular Complications Related to Microaxial Assist Device Use: A Case‐Level Systematic Review

George P. Nolan, Magdalena C. Hammond, Daler Rahimov, Chaitanya Karimanasseri, Nayeem Nasher, T. Reese Macmillan, John W. Entwistle, Keshava Rajagopal, Charles W. Hoopes and Vakhtang Tchantchaleishvili
Artificial organs, v 50(4), pp 505-510
Apr 2026
DOI: https://doi.org/10.1111/aor.70056
PMID: 41410269
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1111/aor.70056View
Published, Version of Record (VoR) Open Open Access (License Unspecified)

Abstract

Background Microaxial devices provide effective short‐term hemodynamic support in patients with cardiogenic shock or during high‐risk procedures. However, there is a paucity of data regarding device‐associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes. Methods An electronic search was conducted in October 2024 to identify studies reporting microaxial device–associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient‐level data were extracted for analysis. Results The median age was 50 years [IQR 34–65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high‐risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3–15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In‐hospital/30‐day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre‐existing bioprosthetic aortic valve (p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow‐up of 183 [30–365] days, overall survival was 89% (24/27). Conclusion AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury. Aortic regurgitation predominated; however, all mitral regurgitation cases were severe and associated with increased mortality. Surgical management was the most common approach for device‐associated valvular injury.

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Collaboration types
Domestic collaboration
Web of Science research areas
Engineering, Biomedical
Transplantation
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