CARC5: Midterm Impella Support: A Review of Seventy-Two Patients Successfully Supported with Impella 5.5 Device

Abstract

Introduction: Impella 5.5 is an FDA-approved microaxial, continuous flow pump intended to provide left ventricular hemodynamic support for 14 days. We report 72 consecutive patients supported with this device, many for extended durations. Methods: The outcomes of patients at an academic hospital from March 2021 to December 2022 are included. Results: Seventy-two patients required 76 Impella 5.5 devices. Of the 72 patients, 65 patients (90.3%) were male with a mean age of 55.4 (+/- 12.5). The majority of patients had a heart failure etiology of NICMP (40, 55.6%), followed by ICMP (24, 33.3%), post cardiotomy shock (3, 4.2%), planned post cardiotomy support (3, 4.2%), and other (2, 2.8%). Fourteen patients (19.4%) were SCAI C, 35 patients (48.6%) SCAI D, and 23 patients (31.9%) SCAI E. Twenty-three (31.9%) patients were INTERMACS 1 (IMX), followed by 46 (63.9%) with IMX 2. The majority of Impella 5.5 devices were placed as a bridge to decision (37 patients, 51.4%), followed by bridge to transplant (19 patients, 26.4%), bridge to recovery (11 patients, 15.3%) and bridge to durable LVAD (5 patients, 6.9%). Pre-Impella 5.5 MCS was provided by VA-ECMO (24 patients, 33.3%), temporary LVAD (8, 11.1%), RVAD (1, 1.4%) and IABP (11 patients, 15.2%). Nine patients required interval escalation to concomitant VA-ECMO. Among patients with explant data, 30 received Impella 5.5 support for < 2 weeks, 26 for 2-4 weeks, and 12 for > 4 weeks. Of patients reaching a primary endpoint, 29 were transplanted (40.3%), 12 patients received a durable LVAD (16.7%), 9 were discharged without VAD or transplant (12.5%), 15 died (20.8%), 4 were transferred while still on Impella support (5.6%), 2 patients are currently still supported (2.8%), and 1 patient (1.4%) was explanted pending final outcome. With respect to complications, 3 patients suffered strokes while on support, 2 had a pump thrombosis (one with additional brachial thrombus), 2 had fiberoptic cable malfunctions, 2 had purge line leaks, and there was 1 patient each with a broken optical sensor, disrupted connector cable halting device function, and axillary thrombus. Conclusion: The Impella 5.5 device is an excellent left ventricular support device, which can provide extended periods of hemodynamic supplementation, facilitating bridge to durable support or recovery.