Perioperative cardiogenic shock can be fatal, and assisted circulation with an Impella percutaneous ventricular support pump catheter is useful in patients with severely compromised cardiac function. However, we report a case in which an Impella implanted preoperatively deepened its position during off-pump coronary artery bypass grafting decannulation. This change in position caused the Impella to interfere with the posterior mitral valve leaflet and led to severe mitral regurgitation and difficulty with intraoperative circulatory control. In patients without significant left ventricular enlargement, the heart team should discuss the risk of interference with the mitral valve and inhalation failure during decannulation. In such cases, other forms of assisted circulation, such as intra-aortic balloon pumping or cardiopulmonary bypass, should be considered. 

Keisuke Sumii graduated from medical school in Japan in 2009, I have worked as an anesthesiologist for 8 years after 2 years of clinical training. I am currently working at a 450-bed acute care hospital in Saitama, Japan, where I am mainly responsible for cardiac anesthesia.