Extended Support With the Impella 5.5: Transplant, ECMO, and Complications

Abstract

We report midterm results of Impella 5.5 use with focus placed on bridge-outcomes, venoarterial extracorporeal membrane oxygenation (VA-ECMO) transition, complications, and risk factors for mortality. A retrospective review of patients implanted with the Impella 5.5 at our medical center was conducted. Forty patients were included with varying bridge strategies. Sixteen (40%) patients were supported for <14 days, 13 (32.5%) for 14-30 days, and 11 (27.5%) for >30 days. Thirty day mortality was 22.5% (9/40). Twenty-five (62.5%) were successfully bridged to transplant or durable left ventricular assist device (LVAD), while four (10.0%) recovered without the need for any further cardiac support. Five of 11 (60%) patients initially supported with VA-ECMO were either transitioned to durable left ventricular assist device (dLVAD; n = 3, 27.3%), transplanted (n = 1, 9.1%), or recovered (n = 1, 9.1%). Of nine patients with >moderate right ventricle (RV) dysfunction, five (55.6%) were successfully bridged to transplant or LVAD. Five (12.5%) patients required interval cannulation to VA-ECMO, often in the setting of RV dysfunction, and all (100%) were successfully transplanted. Lower pulmonary artery (PA) systolic pressure (P = 0.029), among other factors, was associated with mortality. In summary, the Impella 5.5 may be able to effectively stabilize patients in refractory left ventricular predominant cardiogenic shock for extended durations, allowing time for mechanical circulatory support (MCS) and transplant evaluations.

Optimizing Perioperative Care for Ventricular Tachycardia Ablation in High-Risk Patients Supported by Impella 5.5

“…Previous generations of the Impella devices, namely, the Impella 2.5 and Impella CP, are placed percutaneously through the femoral artery into the ascending aorta and then to the left ventricle. The Impella 5.5 offers numerous advantages compared to previous iterations of these devices, such as greater flow rate, more precise position monitoring, enhanced hemocompatibility, reduced motor size, and a lack of a pigtail catheter [ 10 , 11 ]. In contrast, the pigtail catheter of Impella 2.5, CP, and 5.0 is a distinguishing feature from Impella 5.5 and is used to provide stability during implantation [ 2 ].…”

Surgically implanted endovascular, microaxial left ventricular assist device: A single institution study

“…Recent data have been published regarding the safety and short-term outcomes of this device. These studies have been limited to small, single-center case series 3 , 4 and larger multi-institutional, industry-driven studies. 5 , 6 Thus, we sought to describe detailed outcomes with the use of the Impella 5.5 at a large heart failure center.…”