Bridging to Heart Transplantation With Intraaortic Balloon Pump Versus Impella 5.5

In this study, we compare the clinical characteristics and courses of patients directly bridged to heart transplant with intraaortic balloon pump (IABP) versus Impella 5.5. We performed a retrospective cohort study of single-center institutional data including all adult patients at our institution bridged to transplant with either IABP or Impella 5.5 support between October 18, 2018, and May 31, 2023. Ninety-one heart transplant recipients were included in this study, of whom 54 (59%) were bridged on IABP and 37 (41%) were bridged on Impella 5.5. Patients supported with Impella 5.5 had comparable baseline characteristics compared to those bridged on IABP (all p > 0.05). However, Impella 5.5 patients had lower vasoactive inotropic scores during their temporary mechanical circulatory support (MCS) period than those bridged on IABP (all p < 0.05). Duration of MCS and post-transplant intensive care unit (ICU) length of stay were longer for Impella 5.5 patients (all p < 0.05), but rates of complications after transplant were comparable (all p > 0.05). Survival at 1 year post-transplant was significantly greater for the Impella 5.5 group (100% vs. 87%; p = 0.039). Given the increased use of MCS as a bridge to transplant, this project has important implications for preoperative management of waitlist patients.