Abstract
Background: Limited donor organ availability necessitates the use of mechanical circulatory support (MCS) as a bridge to transplant for patients in medically refractory end-stage heart failure. The increasing availability, flow capability and durability of the Impella 5.5 percutaneous LVAD has benefitted patients with its minimally invasive nature. We present a single-center case series of patients supported with Impella 5.5 to OHT, demonstrating the safety and feasibility of this approach in what is, to our knowledge, the largest reported series to date. Methods: From January 2021 to present, 31 consecutive patients supported by Impella 5.5 underwent OHT at our institution. Demographic data, etiology of illness, details of procedures, duration of support, postoperative complications, and outcomes were analyzed. We additionally report two different methods of complete device removal during OHT – via device transection in the field versus removal from the axillary insertion site. Results: Of 31 patients, 80.7% (25/31) were male and the average age was 49.5 (21-70) years. The etiology of cardiomyopathy was predominantly nonischemic in 77.4% (24/31) of patients. Average length of stay was 78.2 days (27-229) with an average 53.1 days (19-133) in the intensive care unit. 27 patients (87.1%) had device placed in the right axillary artery, with 3 being on the left. Average Impella 5.5 duration was 29.6 days (2-97). During OHT, 67.7% (21/31) had device transected in the aorta and sent off the field, while the remaining 32.3% had device removal via axillary site. 8 patients (25.8%) underwent multiple organ transplant (7 kidney, 1 liver). Two patients (6.5%) suffered neurological insult. Notably, in both cases, the device was removed via the second method. There was 1 vascular complication, requiring axillary artery repair. Three patients (9.7%) had postoperative acute kidney injury or renal failure. Average days from OHT to discharge were 26.0 (7-80). There was 1 death in a patient who developed mixed septic and cardiogenic shock, and another death in a patient who developed a mediastinal infection several months postoperatively. The 30-day survival rate was 96.8% (30/31). 6.5% (2/31) patients had concern for rejection. Eleven patients (35.5%) were alive at 1 year, while another 18 (58.0%) were alive but had not yet reached 1 year post-transplant. Conclusion: Based on our institutional experience, Impella 5.5 is safe and reliable for prolonged bridge to OHT, as demonstrated in the high 30-day and 1-year survival rates. Complication rates were relatively low while offering a minimally invasive approach and avoiding resternotomy at time of OHT. We speculate that device removal via transection in the ascending aorta poses a lower stroke risk than the more established alternative, but further work will need to demonstrate superiority of either technique. Finally, further studies are needed urgently to determine the optimal MCS approach in patients awaiting OHT. Table 1. Prolonged Impella 5.5 Support as Bridge to Transplant
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
