Impella 5.5 Bridge to Heart Transplant: An Institutional Series and a Closer Look at Device Removal Technique.

ABSTRACT

Limited donor organ availability often necessitates mechanical circulatory support, and recently the Impella 5.5, as a bridge to heart transplant. Of 175 Impella 5.5-supported patients at our institution, 45 underwent transplantation in the largest series to date, for whom we analyzed outcomes. Two methods of complete device explant were evaluated central Impella transection and removal via axillary graft. Median Impella days were 25 (16-41); median waitlist days were 21 (9-37). Eighty-nine percent (40/45) of patients had device placement via right axillary artery. Seventy-six percent (34/45) underwent central transection for device removal. Four patients (8.9%) required short-term venoarterial extracorporeal membranous oxygenation (VA ECMO) postoperatively for primary graft dysfunction (PGD). Two patients (4.4%) suffered postoperative stroke. Five patients (11.1%) required new RRT postoperatively. One patient (2.2%) returned to the operating room (OR) for axillary graft bleeding. A higher chance of procedural complications was found with the axillary removal technique ( p = 0.014). Median intensive care unit (ICU) days, length of stay (LOS), and postoperative days to discharge were 46 (35-63), 59 (49-80), and 18 (15-24), respectively. Ninety-eight percent (44/45) survived to discharge. Thirty-day survival was 95.6% (43/45), with 1 year survival at 90.3% (28/31). Eighty-eight percent (37/42) remain without rejection. In our institutional experience, Impella 5.5 is a safe and reliable bridge to transplant.