Impella Device Research Articles

Patient characteristics, management, and outcomes of acute myocardial infarction due to unprotected left main stem occlusion: insights from a real-world multicentre registry over a 12-year period

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute myocardial infarction (AMI) due to unprotected left main coronary artery (LMCA) occlusion is a potentially life-threatening disease. AMI management has evolved over the past two decades, and mortality has decreased considerably. Though, little information on patient characteristics, management, and mortality trends in the most recent years is available regarding acute unprotected LMCA occlusion. Purpose We aimed to assess trends in patient characteristics, management, and outcomes for acute myocardial infarction due to LMCA occlusion between 2008 and 2020. Methods We conducted a retrospective multicentre registry of patients with AMI with unprotected LMCA occlusion admitted in three tertiary hospitals between 2008 and 2020. Patients were divided according to timeline of presentation, and we sought to compare clinical characteristics, management, and outcomes between a past group (from January 2008 to December 2012) and a contemporary group (from January 2017 to December 2020). Results Of 128 patients with AMI from unprotected LMCA occlusion, 28 were included in the past group [from January 2008 to December 2012 (group 1)] and 48 were included in the contemporary group [from January 2017 to December 2020 (group 2)]. No statistically significant differences in baseline risk factors were found between the two groups, except for hypertension (50.0% in group 1 vs 75.0% in group 2, p=0.027). There was no difference regarding presentation with cardiogenic shock (57.1% vs 64.6%, p=0.520). Median symptom-to-balloon time was high but similar in both groups [180 min (120-300) vs 210 min (120-420), p=0.640]. Radial access was more frequent used in the contemporary group (33.0% vs 10.7%, p=0.028), as well as the administration of glycoprotein IIb/IIIa inhibitors (14.6% vs 12.0%, p=0.004) and the implantation of drug-eluting stents (100% vs 63.2%, p=0.010). The use of mechanical circulatory support device was surprisingly higher in group 1 (82% vs 46%, p=0.002), but the intra-aortic pump balloon (IABP) was the only device available in that group. In the contemporary group, the use of IABP, Impella device, and extracorporeal membrane oxygenation was 37.5%, 20.8%, and 2.1%, respectively. The second antiplatelet agent was also different between groups, with a higher percentage of ticagrelor loading in the contemporary group. In-hospital mortality (46.4% in group 1 vs. 54.2% in group 2, p=0.520) and 1-year cumulative mortality (60.7% vs 60.4%, p=0.741) were high in both groups, but no statistically significant difference was found in survival analysis (p=0.794; log-rank test). Conclusion In our real-world population, despite the use of newer drugs and more advanced devices being more common in the contemporary group, patients with AMI due to LMCA occlusion are still a subpopulation with poor prognosis. Innovative strategies are needed to make a difference.

Short-term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device.

We sought to investigate the outcomes of heart transplant patients supported with Impella 5.5 temporary mechanical circulatory support. Patient demographics, perioperative data, hospital timeline, and haemodynamic parameters were followed during initial admission, Impella support, and post-transplant period. Vasoactive-inotropic score, primary graft failure, and complications were recorded. Between March 2020 and March 2021, 16 advanced heart failure patients underwent Impella 5.5 temporary left ventricular assist device support through axillary approach. Subsequently, all these patients had heart transplantation. All patients were either ambulatory or chair bound during their temporary mechanical circulatory support until heart transplantation. Patients were kept on Impella support median of 19days (3-31) with the median lactate dehydrogenase level of 220 (149-430). All Impella devices were removed during heart transplantation. During Impella support, patients had improved renal function with median creatinine serum level of 1.55mg/dL decreased to 1.25 (P=0.007), pulmonary artery pulsatility index scores increased from 2.56 (0.86-10) to 4.2 (1.3-10) (P=0.048), and right ventricular function improved (P=0.003). Patients maintained improved renal function and favourable haemodynamics after their heart transplantation as well. All patients survived without any significant morbidity after their heart transplantation. Impella 5.5 temporary left ventricular assist device optimizes care of heart transplant recipients providing superior haemodynamic support, mobility, improved renal function, pulmonary haemodynamics, and right ventricular function. Utilizing Impella 5.5 as a direct bridging strategy to heart transplantation resulted in excellent outcomes.

E-46 | Bedside Removal of Impella Devices in Cardiogenic Shock Patients Is Feasible and Safe

Patients with cardiogenic shock (CS) requiring mechanical circulatory support (MCS) are complex. The Impella CP (Abiomed, Danvers, MA) is a percutaneously placed left ventricular assist device and there is no established best-practice for device removal. Vascular complications from MCS devices are common and many patients undergo operative removal of these devices. To our knowledge there is no published data concerning the safety of bedside removal of femorally-placed Impella devices in the cardiovascular intensive care unit (CICU) for patients with CS. We conducted a retrospective chart review of all CS patients requiring MCS at our institution in 2020, approved by our institutional review board. In 2020 we cared for 84 patients requiring MCS in our CICU, excluding patients with intra-aortic balloon pumps. Of these, 55 patients had a femorally-placed Impella CP, either alone or with veno-arterial extracorporeal membrane oxygenation. 18 patients died with devices in place and three were transferred to another facility on MCS. 14 patients had their Impella removed in the operating room and five in the cardiac catheterization lab. 15 total patients (27%) underwent Impella removal at bedside in the CICU. Of the patients with bedside removal, a vascular closure device was used in the vast majority (87%). Only one patient had post-removal leg ischemia requiring surgical or endovascular intervention; this patient had preexisting peripheral vascular disease and the Impella was removed via manual pressure for clinical ischemia. Bedside removal of femorally-placed Impella CP devices is feasible and safe in select CS patients. More research is needed to establish best-practices for MCS device removal.

The Role of the Percutaneous Impella Pump in Anesthesia and Intensive Care

The use of temporary mechanical circulatory support (tMCS) devices and in particular the increasing use of the Impella device family has gained significant interest over the last two decades. Nowadays, its use plays a well-established key role in both the treatment of cardiogenic shock, and as a preventive and protective therapeutic option during high-risk procedures in both cardiac surgery and cardiology, such as complex percutaneous interventions (protected PCI). Thus, it is not surprising that the Impella device is more and more present in the perioperative setting and especially in patients on intensive care units. Despite the numerous advantages such as cardiac resting and hemodynamic stabilization, potential adverse events exist, which may lead to severe, but preventable complications, so that adequate education, early recognition of such events and a subsequent adequate management are crucial in patients with tMCS. This article provides an overview especially for anesthesiologists and intensivists focusing on technical basics, indications and contraindications for its use with special focus on the intra- and postoperative management. Furthermore, troubleshooting for most common complications for patients on Impella support is provided.

Outcomes of surgical Impella placement in acute cardiogenic shock

Introduction Although a role for percutaneous Impella devices has been established, there is a paucity of data regarding the utility and outcomes of larger surgically implanted Impella devices. Methods We conducted a retrospective review of all surgical Impella implants at our institution. All Impella 5.0 and Impella 5.5 devices were included. The primary outcome was survival. Secondary outcomes included hemodynamic and end-organ perfusion as well as commonly encountered surgical complications. Results From 2012 to 2022, 90 surgical Impella devices were implanted. The median age was 63 [53–70] years, the mean creatinine was 2.07 ± 1.22 mg/dL, and the average lactate level was 3.32 ± 2.90 mmol/L. Prior to implantation, 47 patients (52%) were supported with vasoactive agents, while 43 (48%) were also supported with another device. The most common etiology of shock was acute on chronic heart failure (50, 56%), followed by acute myocardial infarction (22, 24%), and postcardiotomy (17, 19%). Overall, 69 patients (77%) survived to device removal, and 57 (65%) survived to hospital discharge. One-year survival was 54%. Neither etiology of heart failure nor device strategy was associated with 30-day or 1-year survival. On multivariable modeling, the number of vasoactive medications prior to device implantation was strongly associated with 30-day mortality (hazard ratio 1.94 [1.27–2.96], P < 0.01). Surgical Impella placement was associated with a significant decreased need for vasoactive infusions (P < 0.01) and decreased acidosis (P = 0.01). Conclusions Surgical Impella support for patients in acute cardiogenic shock is associated with lower vasoactive medication use, improved hemodynamics, increased end-organ perfusion, and acceptable morbidity and mortality.

Use of Percutaneous Left Ventricular Assist Device Before Durable Device Implantation in Patients With Cardiac Cachexia: Case Series.

Frailty and malnutrition in patients with heart failure are barriers to durable left ventricular assist device (D-LVAD) support and heart transplantation. Moreover, cachexia in patients with advanced heart failure carries a high mortality risk. There are no guidelines for these patients other than increased caloric intake and rehabilitation. Patients suffering from cardiac cachexia and heart failure may benefit from temporary, percutaneous assist device support to improve the underlying heart disease and reverse the catabolic state. We retrospectively reviewed patients from January 2017 to January 2022. All patients who received Impella support (5.0 or 5.5, Abiomed) before D-LVAD implantation were screened. Those who met the criteria for cardiac cachexia were included. Patient demographics, nutritional and biochemical markers, and survival data were collected. A total of 14 patients were included. The majority of patients were male (85.7%) with ischemic cardiomyopathy (64.3%). Caloric intake, physical strength, and ambulation improved. Prealbumin levels improved from a median of 13.7-18.0 mg/dl ( p < 0.006) while on Impella 5.0 or 5.5 support. All patients survived to discharge and the 6 month follow-up. In conclusion, use of the Impella device improves cardiogenic shock symptoms and, consequently, may improve cachexia status prior to D-LVAD implantation.

Percutaneous coronary intervention with Impella support with and without intra-aortic balloon in cardiogenic shock patients

ObjectiveTo assess the clinical characteristics and in-hospital bleeding complications and major adverse cardiac and cerebrovascular events (MACCE) associated with the use of Impella alone or the combination of an intra-aortic balloon pump (IABP) with Impella in cardiogenic shock (CS) patients undergoing percutaneous coronary intervention (PCI). MethodsAll CS patients who underwent PCI and were treated with an Impella mechanical circulatory support (MCS) device were identified. Patients were divided into two groups: having MCS support with Impella alone or with both, IABP and Impella simultaneously (dual MCS group). Bleeding complications were classified by a modified Bleeding Academic Research Consortium (BARC) classification. Major bleeding was defined as BARC≥3 bleeding. MACCE was the composite of in-hospital death, myocardial infarction, cerebrovascular events and major bleeding complications. ResultsBetween 2010 and 2018 a total of 101 patients were treated at six tertiary care New York hospitals with either Impella (n = 61) or dual MCS with Impella and IABP (n = 40). Clinical characteristics were similar for both groups. Dual MCS patients presented more often with a STEMI (77.5 % vs. 45.9 %, p = 0.002) and had left main coronary artery intervention (20.3 % vs. 8.6 %, p = 0.03). Major bleeding complications (69.4 % vs. 74.1 %, p = 0.62) and MACCE rates (80.6 % vs. 79.3 %, p = 0.88) were very high but similar in both groups, however access site bleeding complications were lower in patients treated with dual MCS. In-hospital mortality was 29.5 % for the Impella group and 25.0 % for the dual MCS group (p = 062). Access site bleeding complications were lower in in patients treated with dual MCS (5.0 % vs. 24.6 %, p = 0.01). ConclusionIn CS patients undergoing PCI with either the Impella device alone or with Impella and IABP, major bleeding complications and MACCE rates were high but not significantly different between the two groups. In hospital mortality was relatively low in both MCS groups despite the high-risk characteristics of these patients. Future studies should assess the risks and benefits of the simultaneous use of these two MCS in CS patients undergoing PCI.

(31) Mid-Term Survival in Patients with Advanced Heart Failure Receiving an Impella Device Intended as Bridge to Transplantation

(31) Mid-Term Survival in Patients with Advanced Heart Failure Receiving an Impella Device Intended as Bridge to Transplantation

IABP versus Impella Support in Cardiogenic Shock: “In Silico” Study

Cardiogenic shock (CS) is part of a clinical syndrome consisting of acute left ventricular failure causing severe hypotension leading to inadequate organ and tissue perfusion. The most commonly used devices to support patients affected by CS are Intra-Aortic Balloon Pump (IABP), Impella 2.5 pump and Extracorporeal Membrane Oxygenation. The aim of this study is the comparison between Impella and IABP using CARDIOSIM© software simulator of the cardiovascular system. The results of the simulations included baseline conditions from a virtual patient in CS followed by IABP assistance in synchronised mode with different driving and vacuum pressures. Subsequently, the same baseline conditions were supported by the Impella 2.5 with different rotational speeds. The percentage variation with respect to baseline conditions was calculated for haemodynamic and energetic variables during IABP and Impella assistance. The Impella pump driven with a rotational speed of 50,000 rpm increased the total flow by 4.36% with a reduction in left ventricular end-diastolic volume (LVEDV) by ≅15% to ≅30%. A reduction in left ventricular end systolic volume (LVESV) by ≅10% to ≅18% (≅12% to ≅33%) was observed with IABP (Impella) assistance. The simulation outcome suggests that assistance with the Impella device leads to higher reduction in LVESV, LVEDV, left ventricular external work and left atrial pressure-volume loop area compared to IABP support.

A Post-closure Technique Using a Single Perclose Device in the Removal of a Transfemoral Impella Catheter

Objective: A transfemoral Impella can substantially support patients with cardiogenic shock, and surgical closure has conventionally been used for the removal of large-bore catheters. However, while percutaneous closure is a prompt and minimally invasive technique, single Perclose post-closure outcomes remain to be evaluated. The present study evaluated the safety and efficacy of single Perclose post-closure in the removal of transfemoral Impella catheters.Methods: Of 37 patients supported by an Impella device, 25 patients (68%) were excluded due to a transsubclavian approach, an inability to wean, or primary surgical closure. We reviewed 12 patients (32%) receiving the single Perclose post-closure method. For percutaneous closure, we inserted a 0.035-inch guidewire through the side port of the Impella device and extracted the device while retaining the guidewire. Single Perclose was deployed with an additional maneuver as backup, such as second Perclose or surgical closure. The outcomes were defined according to the Valve Academic Research Consortium-2 criteria.Results: All patients had received the Impella CP due to cardiogenic shock. All patients received single/dual antiplatelets without oral anticoagulants. Percutaneous closure was successful in 11 patients (92%); the remaining patient was converted to surgical closure. The mean (range) procedural time was 8.0 (5.8–9.0) minutes. Major bleeding and vascular complications were observed only in the patient with surgical conversion (8.3%). No closure-site infection or closure-related limb ischemia was observed. All patients were discharged alive after the removal of the Impella device.Conclusion: Single Perclose post-closure is a promising closure method for removing a transfemoral Impella, but further investigations are needed.

Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data.

Placement of percutaneous ventricular support devices such as an intraaortic balloon pump (IABP) or Abiomed Impella device can treat severe cardiogenic shock. Critical care transport medicine (CCTM) providers frequently manage patients supported by these devices during interfacility transfers, often using a helicopter air ambulance (HAA). An understanding of patient needs and management during transport is essential to informing crew configuration and training, and this study adds to the limited existing data on the HAA transport of this complex patient population. We performed a retrospective chart review of all HAA transports of patients with an IABP (n = 38) or Impella (n = 11) device at a single CCTM program from 2016 to 2020. We evaluated transport times and composite variables for the frequency of adverse events, condition changes requiring critical care evaluation, and critical care interventions. In this observational cohort, patients with an Impella device more frequently had an advanced airway and at least 1 vasopressor or inotrope active prior to transport. While flight times were similar, CCTM teams remained at referring facilities longer for patients with an Impella device (99 vs 68 minutes; p = 0.0097). Compared to patients with an IABP, patients with an Impella device more frequently had a condition change requiring critical care evaluation (100% vs 42%; p = 0.0005) and more frequently received critical care interventions (100% vs 53%; p = 0.0037). Adverse events were uncommon and did not differ for patients with an Impella device compared to an IABP (27% vs 11%; p = 0.178). Patients requiring mechanical circulatory support with IABP and Impella devices frequently require critical care management during transport. Clinicians should ensure the CCTM team has appropriate staffing, training, and resources to meet the critical care needs of these high acuity patients.

Use of the Impella device in ambulatory heart failure and pre-heart transplant patients - one medical center’s experience

Background and objective: The prevalence of heart failure (HF) in the US has increased over several years. The American Heart Association (AHA) documents that HF has a prevalence of 6 million cases among Americans aged 20 years and older. HF is a complex syndrome that results from the structural or functional impairment of ventricular filling or ejection of blood, leading to symptoms including poor exercise tolerance, shortness of breath, and signs of HF such as edema and rales. The aim of the study was to add to the knowledge base from one medical center's experience using Impella device in ambulatory heart failure and pre-heart transplant patients.Results: The axillary Impella enables HF patients to ambulate inside the CICU while waiting for destination therapy. RNs in our medical center's CICU can take care of these patients effectively and competently because of extensive prior experiences with the AxIABP. Nursing staff have adapted existing nursing procedures, protocols, and lessons learned from experiences with the AxIABP to manage this new patient population.Discussion: Impella is one treatment option in advanced HF and pre-heart transplant patients. The development of an alternative insertion technique that allows patients to ambulate instead of being on bedrest continues to evolve. Our medical center’s experiences with taking care of ambulatory HF and pre-heart transplant Impella patients have shown that this is a safe and effective treatment.

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

Mechanical Assist Device-Assisted Percutaneous Coronary Intervention: The Use of Impella Versus Extracorporeal Membrane Oxygenation as an Emerging Frontier in Revascularization in Cardiogenic Shock.

The extracorporeal membrane oxygenation (ECMO) procedure aids in the provision of prolonged cardiopulmonary support, whereas the Impella device (Abiomed, Danvers, MA) is a ventricular assist device that maintains circulation by pumping blood into the aorta from the left ventricle. Blood is circulated in parallel with the heart by Impella. It draws blood straight into the aorta from the left ventricle, hence preserving the physiological flow. ECMO bypasses the left atrium and the left ventricle, and the end consequence is a non-physiological flow. In this article, we conducted a detailed analysis of various publications in the literatureand examined various modalities pertaining to the use ofECMO and Impella for cardiogenic shocks, such as efficacy, clinical outcomes, cost-effectiveness, device-related complications, and limitations. The Impella completely unloads the left ventricle, thereby significantly reducing the effort of the heart. Comparatively, ECMO only stabilizes a patient with cardiogenic shock for a short stretch of time and does not lessen the efforts of the left ventricle ("unload" it). In the acute setting, both devices reduced left ventricular end-diastolic pressure and provided adequate hemodynamic support. By comparing patients on Impella to those receiving ECMO, it was found that patients on Impella were associated with better clinical results, quicker recovery, limited complications, and reduced healthcare costs; however, there is a lack of conclusive studies performed demonstrating the reduction in long-term mortality rates. Considering the effectiveness of given modalities and taking into account the various studies described in the literature, Impella has reported better clinical outcomes although more clinical trials are needed for establishing the effectiveness of these interventional approaches in revascularization in cardiogenic shock.

Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery.

The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes. Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%). The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.

Comparison of Inotropes for Use With the Impella Device in Cardiogenic Shock.

Comparison of Inotropes for Use With the Impella Device in Cardiogenic Shock.

579 ACUTE ISCHEMIC HEART FAILURE: PHARMACOLOGICAL AND INTERVENTIONAL MANAGEMENT OF A FRAIL PATIENT

Abstract An 87-year-old male patient with worsening dyspnea was admitted to our institution. The patient had a history of acute myocardial infarction treated with coronary stenting of the left descending artery (LAD), diagonal (Diag), right coronary artery (RCA), and chronic kidney disease. For acute pulmonary edema, the patient was admitted to our cardiac intensive care unit and rapidly treated with non-invasive positive-pressure ventilation with continuous positive airway pressure (C-PAP), IV high dosage diuretic therapy, inotropes, and vasoactive agents. Chest X-ray revealed cardiomegaly (cardiothoracic ratio, 56%) and pulmonary congestion. Electrocardiogram revealed sinus tachycardia and diffuse ST-segment abnormalities. An echocardiogram demonstrated left ventricular apical akinesia, with a left ventricular ejection fraction (LVEF) of 25% and severe mitral regurgitation. Blood tests revealed very high levels of NT-pro-brain natriuretic peptide (NT-proBNP) (&amp;gt;30000 pg/ml) and myocardial necrosis markers (hs-Trop 5055 ng/l; CK-MB 72 ng/ml). After 24 hours, the patient was placed on intra-aortic balloon pump (IABP) support to further hemodynamic support through the right femoral artery, nonetheless, he showed no improvement in symptoms or urine output. Because of a state of hypoxemic and hypercapnic respiratory failure, non-invasive ventilation (NIV) was given to the patient with a gradual improvement in blood gas analysis. The optimization of diuretic therapy allowed to treat the state of acute oliguric kidney disease, avoiding dialytic treatment. After 48 hours, because of a new worsening in hemodynamic state, we decided for a percutaneous left ventricular assist device (Impella CP, Denver, Massachusetts, USA). After placing the Impella device, coronary angiography was performed, showing critical stenosis of the left main (LM), involving the origin of the left anterior descending artery and a collateralized chronic occlusion of the circumflex artery and the LAD, after the origin of a large first diagonal branch. Because of the high procedural risk, we decided to perform only percutaneous coronary intervention and stent implantation of LM. After 3 days his symptoms improved, the required dose of inotropic agents and furosemide decreased and Impella was removed. After 12 days the patient was admitted to the cardiological ward and discharged after 21 days because of a urinary infection requiring antibiotic therapy. The management of acute heart failure in very old patients is challenging, limiting in many cases the use of invasive procedures such as coronary angiography or left ventricular assist devices. In this case, although the patient presented a very high-risk profile considering age and comorbidities, the use of Impella resulted to be safe and guaranteed hemodynamic support during the procedure of revascularization and in the immediate post-operative phase.

Incidence and severity of thrombocytopenia associated with use of intravascular microaxial ventricular assist devices for treatment of cardiogenic shock.

The use of temporary mechanical circulatory support (MCS) for patients with refractory cardiogenic shock has increased over the past decade. Impella devices (intravascular microaxial ventricular assist devices [VADs]) have become common MCS options but reportedly cause thrombocytopenia. Limited published data regarding the incidence or severity of microaxial VAD-associated thrombocytopenia exists. The goal of this study was to determine the incidence, timing, and severity of thrombocytopenia in a microaxial VAD population. A retrospective multicenter review of electronic medical records identified all patients implanted with microaxial VAD at three US academic teaching hospitals between June 2015 and August 2017. Patients were excluded for short-term procedural microaxial VAD use during percutaneous coronary intervention. Sixty-four patients underwent microaxial VAD insertion (95% for left-sided support) during the observed time period. Support was in place for a median duration of 5.2 (interquartile range [IQR]: 2.4-10.0) days. Within 7 days postinsertion, 98.5% of patients developed thrombocytopenia (platelet count <150,000/μl) and 81.3% of patients experienced a>50% platelet decrease. Average platelet count nadir was 68,200/μl or 63.9% from baseline occurring on median day 3.8 (IQR: 2.4-5.4). Twenty-four patients (38.1%) were tested for heparin-induced thrombocytopeniaby the heparin-dependent antibody (HDA) test. All HDAs were either negative or had serotonin release assay negative confirmation. Postdevice removal, platelet counts returned to baseline or >150,000/μl in 63% of patients by Day 5. Microaxial VAD-associatedthrombocytopenia is common. Practitioners should consider this when evaluating supported patients for other causes of thrombocytopenia. Platelet counts return to preimplantation levels within days of device removal.

Successful trans-femoral retrieval of a stuck axillary Impella 5.0 device.

We describe a case in which an axillary Impella 5.0, stuck in an area of calcification in the right subclavian artery, could not be retrieved in the usual manner. However, it was successfully removed using a long 22-Fr sheath and snaring catheter by means of the trans-femoral artery. Device retrieval using the trans-femoral artery snare technique is considered a valid option for removing the Impella device in patients who exhibit this complication.

Waitlist and transplant outcomes for patients bridged to heart transplantation with Impella 5.0 and 5.5 devices.

Impella devices are increasingly utilized as a bridge to heart transplantation (BTT) and are now prioritized as Status 2 under the current heart allocation policy. This study evaluated waitlist and post-transplant outcomes of patients supported with Impella 5.0/5.5 devices. The United Network of Organ Sharing registry was used to identify adults waitlisted or transplanted with Impella 5.0 or 5.5 devices from 2010 to 2021. Separate analyses were performed for waitlist and transplantation outcomes for patients supported by Impella 5.0/5.5 devices. Competing outcomes for the waitlist analysis included rates of transplantation, recovery, and death or clinical deterioration. Among patients undergoing transplantation, the primary outcome was 1-year survival. Secondary outcomes included rates of rejection, new postoperative dialysis, stroke, and pacemaker implantation after transplantation. There were 344 patients waitlisted and 394 patients transplanted with an Impella 5.0 (n = 212 and 251) or 5.5 (n = 132 and 143) device. Competing risk regression demonstrated similar likelihood of transplant (subhazard ratio [SHR], 1.33 (0.98-1.81, p = 0.067)) and similar likelihood of death or clinical deterioration (SHR, 0.67 [0.27-1.69, p = 0.400]) for Impella 5.5 patients. In the transplanted cohort, unadjusted 1-year post-transplant survival was comparable at 91.3% versus 94.6% (log-rank p = 0.661) for patients supported by Impella 5.0 or 5.5 device, respectively, a finding that persisted after risk-adjustment (HR 1.22, p = 0.699). Post-transplant complication rates were also comparable between 5.0 and 5.5 patients. Impella devices can be used as a BTT with excellent survival and minimal post-transplant morbidity. Outcomes were comparable for Impella 5.0 and 5.5 devices.