P7: The Impact of Impella 5.5 as Bridge to Transplant at a Medium Volume Cardiac Transplant Program

Abstract

Purpose: The changes in the 2018 UNOS heart allocation policy has allowed sicker patients to be prioritized while awaiting transplantation. Traditionally, bridging patients with cardiogenic shock to cardiac transplantation has used inotropes, intraaortic ballon pumps (IABP) or durable ventricular assist devices (VAD). Impella 5.5 has emerged as a new modality of support to bridge patients with HF NYHA Class IV/D, SCAI C/D to cardiac transplant. We analyzed the impact of Impella 5.5 in bridging patients to transplantation at Tampa General Hospital (TGH) in 2022, specifically looking at the impact on waitlist time, post-transplant ICU length of stay (LOS), total LOS, and complications while on support. Methods: We retrospectively analyzed our center’s cohort of Impella 5.5 supported patients who were bridged to a heart transplant in 2022 as compared to all patients recieving heart transplant in our program to evaluate median time to transplant on support, ICU and total LOS post-transplant. In 2022, a total of 60 patients in cardiogenic shock were supported with Impella 5.5. Of these, 16 patients were bridged to transplantation. In total, this represented 32% (16/50) of our transplanted patients. The majority were male (15/16), average age of 52, 10/15 supported on Impella 5.5 and inotropes, 12/16 blood type 0, 5/16 had ischemic etiology. Median time on Impella 5.5 support prior to transplant was 13 days at TGH vs 19 days in the 2022 Abiomed registry. The overall median time in hospital prior to transplant during 2022 at TGH was 12 days. Post-transplant ICU LOS for Impella 5.5 supported patients was mean/median 16/11 days vs the program 15/10 days. Post-transplant mean/median total LOS for Impella 5.5 supported patients was 31/25 days vs 28/21 days for the program. There were 3 insertion site hematomas, one CVA and 2 Impella 5.5 induced VT as complications. Survival to transplant was 100%. Results: Impella 5.5 is a safe and efficient way to bridge NYHA Class IV/D, SCAI C/D patients to cardiac transplant, however, it may identify sicker patients as it translates in longer waitlist time as well as post-transplant to discharge time.