Outcomes of Hemodynamic Support With Impella for Acute Myocardial Infarction Complicated by Cardiogenic Shock at a Rural Community Hospital Without On-Site Surgical Back-up.

Aims: Impella 2.5 and Impella CP (Abiomed) are percutaneous left ventricular assist devices that can be easily deployed in the cardiac catheterization laboratory without need for surgery and provide effective hemodynamic support. The utility of Impella devices for management of acute myocardial infarction complicated by cardiogenic shock (AMI-CS) at a rural community hospital without on-site surgical back-up has not been reported.

TEE-guided transcatheter aortic valve implantation with "zero contrast" - a viable alternative for patients with chronic kidney disease.

Acute kidney injury (AKI) stage II-III has been associated with a higher short-term and long-term mortality after transcatheter aortic valve replacement (TAVR). We present a patient with AKI where fluoroscopic landmarks and TEE imaging were used exclusively, sparing the patient a contrast load, and describe patient-tailored modifications.