Short‐term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device

Abstract

Aims We sought to investigate the outcomes of heart transplant patients supported with Impella 5.5 temporary mechanical circulatory support. Methods and results Patient demographics, perioperative data, hospital timeline, and haemodynamic parameters were followed during initial admission, Impella support, and post‐transplant period. Vasoactive‐inotropic score, primary graft failure, and complications were recorded. Between March 2020 and March 2021, 16 advanced heart failure patients underwent Impella 5.5 temporary left ventricular assist device support through axillary approach. Subsequently, all these patients had heart transplantation. All patients were either ambulatory or chair bound during their temporary mechanical circulatory support until heart transplantation. Patients were kept on Impella support median of 19 days (3–31) with the median lactate dehydrogenase level of 220 (149–430). All Impella devices were removed during heart transplantation. During Impella support, patients had improved renal function with median creatinine serum level of 1.55 mg/dL decreased to 1.25 (P = 0.007), pulmonary artery pulsatility index scores increased from 2.56 (0.86–10) to 4.2 (1.3–10) (P = 0.048), and right ventricular function improved (P = 0.003). Patients maintained improved renal function and favourable haemodynamics after their heart transplantation as well. All patients survived without any significant morbidity after their heart transplantation. Conclusions Impella 5.5 temporary left ventricular assist device optimizes care of heart transplant recipients providing superior haemodynamic support, mobility, improved renal function, pulmonary haemodynamics, and right ventricular function. Utilizing Impella 5.5 as a direct bridging strategy to heart transplantation resulted in excellent outcomes.

Impella 5.5 and mitral transcatheter edge-to-edge repair as a bridge to heart transplantation in a patient with cardiogenic shock

“…In this regard although TEER procedure did not result in omitting HTx, it helped to improve right heart pressures and facilitate clinical course post operation. The Impella 5.5 therapy seems to be associated with a low risk of complications, nevertheless, as our case showed thromboembolic events still pose a risk [2].…”

Evaluation of Left Ventricular Overload and Use of Unloading Techniques in Venoarterial Extracorporeal Life Support: A Nationwide Survey

“…Furthermore, this strategy may allow to better manage the weaning process from VA ECLS, possibly leading to a higher chance of recovery or to bridge the patient to durable LV assist devices or heart transplantation. 7 Surprisingly, Impella was not applied by almost one-third of the enrolled centers and only 10% implemented Impella in more than half of their VA ECLS patients. The common need of public health care systems to meet cost-containment objectives may partially explain this finding.…”