Impella 5.5 as a bridge to heart transplantation: Waitlist outcomes in the United States

Cevasco, Marisa; Shin, Max; Cohen, William G; Helmers, Mark R.; Weingarten, Noah; Rekhtman, David; Wald, Joyce; Iyengar, Amit

doi:10.1111/ctr.15066

Cited by 19 publications

(4 citation statements)

References 29 publications

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“…The study also reported that post-transplant survival of patients bridged with Impella was not adversely impacted after the policy change, and concluded that Impella use would become a lasting strategy for bridging under the new allocation system. This trend was confirmed in a publication by Cevasco and colleagues [ 65 ] examining the newest generation Impella 5.5, which received Food and Drug Administration (FDA) approval in 2019. In this retrospective review of the UNOS database 464 patients were BTT with Impella 5.5, and 378 (81%) patients were directly bridged with the device.…”

Section: New Strategies For Bridging To Heart Transplantmentioning

confidence: 77%

“…In this retrospective review of the UNOS database 464 patients were BTT with Impella 5.5, and 378 (81%) patients were directly bridged with the device. Device complications and failure were uncommon, and waitlist death (7%) and clinical deterioration (5%) were the most common reasons for waitlist removal [ 65 ]. The most common complication post-transplant was acute kidney injury requiring dialysis (16%), and one-year post-transplant survival was excellent (89.5%).…”

Section: New Strategies For Bridging To Heart Transplantmentioning

confidence: 99%

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Bridging Over Troubled Waters—How the United States 2018 Heart Allocation System Altered Transplant Bridging Strategies

James,

Smith

2024

Rev. Cardiovasc. Med.

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As we approach the five-year anniversary of the 2018 heart allocation system in the United States, it is imperative to consider the changing landscape of mechanical circulatory support and the strategies used to bridge patients into heart transplants. This manuscript reviews the history of the heart allocation system, as well as the conditions that led to its multiple revisions. We discuss initial outcomes following the implementation of the new allocation system, including the impact on waitlist mortality and post-transplant outcomes. We also give special consideration to changes in bridging strategies using venoarterial extracorporeal membrane oxygenation (VA ECMO), intra-aortic balloon pumps, and durable left ventricular assist devices (LVADs).

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Section: New Strategies For Bridging To Heart Transplantmentioning

confidence: 77%

Section: New Strategies For Bridging To Heart Transplantmentioning

confidence: 99%

Bridging Over Troubled Waters—How the United States 2018 Heart Allocation System Altered Transplant Bridging Strategies

James,

Smith

2024

Rev. Cardiovasc. Med.

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“…It is also a very good option for the treatment of cardiogenic shock as a bridge to transplant with low pre-and post-transplant complications [41] and causes unloading of the right ventricle and decongestion. At the same time, there is no correlation between the duration of use of the device and renal failure requiring hemodialysis [42]. Finally, the successful use of Impella in both ventricles at the same time is reported with encouraging results [43].…”

Section: Allocation System-graft Distributionmentioning

confidence: 95%

Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

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“…Instead, short-term devices such as Micro-axial flow pumps are preferred due to their less invasive nature compared to other MCS devices [ 99 ]. For example, Impella 5.5 as a BTT demonstrated a 1-year survival rate of 89.5% [ 100 ].…”

Section: Future Perspectives and Innovations Of Bttmentioning

confidence: 99%

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

Roesel,

Nersesian,

Neuber

et al. 2024

Rev. Cardiovasc. Med.

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Heart failure (HF) is a common disease associated with high morbidity and mortality rates despite advanced pharmacological therapies. Heart transplantation remains the gold standard therapy for end-stage heart failure; however, its application is curtailed by the persistent shortage of donor organs. Over the past two decades, mechanical circulatory support, notably Left Ventricular Assist Devices (LVADs), have been established as an option for patients waiting for a donor organ. This comprehensive review focuses on elucidating the benefits and barriers associated with this application. We provide an overview of landmark clinical trials that have evaluated the use of LVADs as a bridge to transplantation therapy, with a particular focus on post-transplant outcomes. We discuss the benefits of stabilizing patients with these systems, weighing associated complications and limitations. Further technical advancements and research on optimal implantation timing are critical to ultimately improve outcomes and securing quality of life. In a world where the availability of donor organs remains constrained, LVADs are an increasingly important piece of patient care, bridging the critical gap to transplantation in advanced heart failure management.

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Impella 5.5 as a bridge to heart transplantation: Waitlist outcomes in the United States

Cited by 19 publications

References 29 publications

Bridging Over Troubled Waters—How the United States 2018 Heart Allocation System Altered Transplant Bridging Strategies

Bridging Over Troubled Waters—How the United States 2018 Heart Allocation System Altered Transplant Bridging Strategies

Heart Transplantation

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

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