{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:52:38Z","timestamp":1787669558519,"version":"build-2736575974"},"reference-count":8,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T00:00:00Z","timestamp":1687564800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:p>Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an \u201cECPELLA\u201d configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.<\/jats:p>","DOI":"10.1177\/02676591231186725","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T10:29:18Z","timestamp":1687602558000},"page":"1277-1279","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Escalation from impella 5.5 to ECPELLA support as a bridge to mitral valve surgery in a patient with degenerative mitral regurgitation"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7179-9786","authenticated-orcid":false,"given":"Vasiliki","family":"Gregory","sequence":"first","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matan","family":"Grunfeld","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul D","family":"Bali","sequence":"additional","affiliation":[{"name":"Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Spielvogel","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Kai","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0247-865X","authenticated-orcid":false,"given":"Suguru","family":"Ohira","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,6,24]]},"reference":[{"key":"bibr1-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.116.005971"},{"key":"bibr2-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1177\/02676591211064721"},{"key":"bibr3-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1253\/circrep.CR-21-0016"},{"key":"bibr4-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001194"},{"key":"bibr5-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14183"},{"key":"bibr6-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2021.01.056"},{"key":"bibr7-02676591231186725","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/ehaa946.1849"},{"key":"bibr8-02676591231186725","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58060698"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591231186725","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591231186725","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591231186725","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:33:27Z","timestamp":1777656807000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591231186725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,24]]},"references-count":8,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1177\/02676591231186725"],"URL":"https:\/\/doi.org\/10.1177\/02676591231186725","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,24]]}}}