Pitfalls of anesthetic management with the Impella(R) 5.0 device: a case series.

BACKGROUND: Impella(R) is an antegrade left ventricular assist device with a pump catheter in the left ventricle. We report three cases in which we experienced some pitfalls with circulatory management during Impella placement due to new-onset aortic insufficiency (AI) associated with device placement or the limited maximum flow rate. CASE PRESENTATION: Three patients developed new-onset AI due to Impella placement. In a patient, the total assisted flow rate was relatively low because of his large body size. In the other patients, in whom the Impella device was used in combination with percutaneous cardiopulmonary support or venoarterial extracorporeal membrane oxygenation (ECMELLA), total flow was maintained at a sufficient level. CONCLUSIONS: New-onset of AI after Impella placement and its limited flow rate are considered to be pitfalls in circulatory management. Management with ECMELLA is considered to be effective during the acute phase when patients have decreased cardiac function.