A Review of the Successful Use of 254 Impella 5.5 Devices in an Advanced Heart Failure Program.

Background: Impella 5.5 (i5.5) is an FDA-approved microaxial, continuous flow pump intended to provide left ventricular hemodynamic support for 14 days. We report 247 consecutive patients supported with 254 i5.5 devices and review the complications during prolonged support.

Methods: The outcomes of patients placed on i5.5 at an academic hospital from March 2021 to January 2025 are included.

Outcome: 247 patients (pts) required 254 Impella 5.5 devices (210 male, 37 female, median age 59.1 years [22-84]). Most had NICMP (122, 49%) followed by ICMP (102, 41%). 31 pts (13%) were SCAI C, 151 (61%) SCAI D, and 64 (26%) SCAI E.

112 pts received i5.5 support for < 2 weeks, 74 for 2-4 weeks, and 51 for >4 weeks. The longest duration was 133 days. Of pts reaching a primary endpoint, 74 were transplanted (30%), 60 received durable VAD (24%), 36 were discharged without VAD or transplant (15%), 48 died (19%).

16 (7%) suffered strokes during or within 24 hours of i5.5 removal. Of those, 6 died, 3 underwent LVAD, 2 underwent transplant, and 5 were discharged with recovery. 6 had pump thrombosis/hemolysis, 2 had pump migration out of ventricle. 1 had purge line leak and possible pump stoppage, 1 had brachial artery thrombosis, and 2 had axillary graft infection. Minor complications included: purge line leaks, rising purge pressures, need for purge TPA, and optical sensor dysfunction. 3 pts had cardioembolic strokes and 1 coronary embolus during long term i5.5 support, leading to a programmatic increase in aPTT goal to 65-75sec. Stable pts are cared for on our stepdown unit.

Conclusion: The Impella 5.5 device is an excellent left ventricular support device, which can provide extended periods of hemodynamic support, allowing time to transition patients failing medical support to advanced therapies. Despite prolonged support times, complication rate is low and select patients may be cared for on a step down unit.