Outcomes of heart transplantation in patients bridged with Impella 5.0: Comparison with native chest transplanted patients without preoperative mechanical circulatory support

Abstract

The Impella (Abiomed, Danvers, MA, USA) has become an important adjunct treatment modality in bridging patients with end‐stage heart failure to recovery or orthotopic heart transplantation (HTx). We compared the outcome of patients directly bridged to HTx with the Impella 5.0 versus patients without mechanical circulatory support (MCS). Patients with no previous sternotomy or MCS, who were transplanted between September 2014 and March 2019 were included in this retrospective analysis. Impella 5.0 was implanted using surgical access and transesophageal echocardiography guidance. Forty‐two out of 155 transplanted patients fulfilled the insertion criteria. Eight (19%) were bridged with Impella 5.0 to HTx. Recipient and donor baseline characteristics were comparable in both groups. There were no significant differences in survival between the groups at 30‐day (94% no MCS vs. 87.5% Impella group, P = .47) or 6 months (94% vs. 87.5%, P = .51). Patients on Impella 5.0 showed a significant recovery of hemodynamic parameters and end‐organ function. Average duration of support to HTx was 16 ± 17 days. Impella 5.0, when used in suitable patients in a timely fashion can be a good strategy for bridging patients to HTx. The axillary approach allows for early extubation and mobilization. Outcomes of patients bridged to HTx with Impella 5.0 in acute cardiogenic shock are comparable to those of patients with no MCS.

Current status and outcomes in heart transplantation: a narrative review

“…Similar improvements have been reported with the use of other temporary MCS devices, with better survival outcomes post-HTx in the current era compared to previous time periods [21]. For candidates who were supported with the Impella 5.0 (Abiomed, Danvers, MA, USA), survival at 6 months post-HTx is reportedly similar to recipients who were not on MCS devices [22].…”

Outcomes of heart transplant recipients bridged with percutaneous versus durable left ventricular assist devices

“…Despite these differences in donor and recipient characteristics, we found no significant difference in 1‐year survival between the two cohorts. Other studies present similar results, with no difference in 30‐day, 6‐month, or 1‐year post‐transplant survival 18,19 . This is in contrast to the pre‐allocation analysis of patients bridged with temporary MCS from the International Society of Heart and Lung Transplantation registry between 2005 and 2016, which found increased post‐transplant mortality in percutaneous temporary LVADs ( n = 75, hazard ratio 1.83, 95% CI 1.09–3.08) compared to durable LVADs 20 .…”

“…While the literature on Impella remains limited, Impella 5.0 has been studied in the context of BTT. Patients in cardiogenic shock who underwent BTT with Impella 5.0 have been shown to have good outcomes and comparable short‐term survival as those bridged without MCS 3,19 . Furthermore, Seese et al.…”

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

“…[22][23][24] One recent study demonstrated that the Impella 5.0 percutaneous axial flow device reduced serum creatinine levels within 24-h of implantation. 25 Bridging with intra-aortic balloon pump (IABP) has been shown to decrease serum creatinine in multiple studies as well. [26][27][28] This analysis evaluated whether these and other forms of temporary MCS were associated with changes in the CKD stage in patients awaiting a heart transplant.…”