Medical Director, Heart Transplant Penn, United States
Background: Impella 5.5 (i5.5) is FDA-approved to provide left ventricular hemodynamic support for 14 days. We have experience with 247 consecutive patients supported with 254 i5.5 devices, most of which are placed to stabilize the patient hemodynamically to provide time to complete advanced therapy evaluation
Methods: The outcomes of patients placed on i5.5 at an academic hospital from March 2021 to January 2025 are included.
Outcome: 247 patients required 254 Impella 5.5 devices. Of the 247 patients, had a heart failure etiology of NICMP (122, 49%), ICMP (102, 41%), post cardiotomy shock (8, 3%), planned post cardiotomy support (2, 0.8%), and other (12, 4.8%). 31 patients (12.5%) SCAI C, 151 (61%) SCAI D, and 64 patients (26%) SCAI E. 72 (29%) patients were Intermacs 1 (IMX), followed by 159 (64%) were IMX 2. The majority of Impella 5.5 devices were placed as a bridge to decision/stabilization (BTD) (121 patients, 49%), followed by bridge to transplant (BTT) (62 patients, 25%), bridge to recovery (BTR) (36 patients, 15%) and bridge to durable LVAD (18 patients, 7%). Of the 121 patients with i5.5 placed as BTD, 25 went on to transplant, 35 to durable VAD, 21 to recovery, 9 transferred on support, and 29 died. Of the 62 patients with i5.5 placed as BTT, 47 went on to transplant, 8 to durable LVAD, 2 deaths, 1 to recovery, 1 transferred during support and received durable VAD at another center, and 3 are still supported and listed for transplant as status 2. We also care for stable i5.5 supported patients on our step down unit to decrease prolonged CICU stays
Conclusion: The Impella 5.5 can provide extended hemodynamic supplementation, allowing time to complete evaluation for advanced therapies in patients failing medical therapy. Support durations may be long for listed patients and select patients may be safely cared for on a stepdown unit
