Prolonged Impella 5.5 Support in Patients with Cardiogenic Shock: A Single-Center Retrospective Analysis

Background: Patients in cardiogenic shock (CS) often require prolonged mechanical circulatory support lasting longer than 14 days. Prolonged support with Impella 5.5 can improve outcomes in these patients. Here, we describe our experience with prolonged Impella 5.5 support. Methods: From January 2023 to June 2024, 64 patients receiving Impella 5.5 support for more than 14 days were identified. Information including demographics, heart failure etiology, and hospital course were collected. Results: Of the 64 patients identified, 54 were male, with an average age of 55.9 years. One patient was classified as SCAI class C, 41 as SCAI class D, and 22 as SCAI class E. Heart failure etiologies included 41 patients with non-ischemic cardiomyopathy, 10 with ischemic cardiomyopathy, 10 with acute myocardial infarction, 1 with cardiac allograft rejection, 1 with post-cavotricuspid isthmus ablation, and 1 with post-cardiotomy (aortic root replacement) CS. The average duration of Impella 5.5 support was 27.1 days. Escalation to Impella 5.5 was observed in 26 patients, with 15 having escalated from intra-aortic balloon pump and 11 from Impella CP. Overall survival, including heart recovery, orthotopic heart transplantation (OHT), or left ventricular assist device (LVAD), was 81.3% (52/64) in patients with Impella 5.5. Patients were discharged after OHT (27/64), cardiac recovery (13/64), or durable LVAD placement (12/64), and 12 patients expired. Conclusions: Our data suggest that Impella 5.5 provides durable support for patients beyond the 14-day period currently approved by the FDA for CS management. Further evaluation of long-term Impella 5.5 support for cardiac recovery or as a bridge to advanced therapies should be considered.