Impact of prolonged microaxial flow pump support on outcomes in heart transplantation: A single-center experience

To evaluate whether patients receiving prolonged Impella 5.5 support (greater than 30 days) as a bridge to heart transplantation experience comparable outcomes with those receiving shorter-term support (up to 30 days).

Institutional data were queried between December 2020 and December 2024 for adult patients who were bridged to heart transplantation with the Impella 5.5 device. Patients were stratified into 2 cohorts on the basis of the duration of Impella support (30 days or less vs more than 30 days). Key end points including in-hospital mortality rate and Impella-related complications were compared.

Of 359 patients who received an Impella 5.5 at our institution, a total of 66 patients were bridged to heart transplantation, which included 45 patients receiving short-term support and 21 patients receiving prolonged support. The proportion of listed patients on short-term and prolonged Impella support who received a HeartMate 3 was 6.7% and 0%, respectively (0.546). The waitlist mortality rate for patients with short-term and prolonged Impella 5.5 support was 8.9% and 14.3%, respectively (P = .645). There was no 90-day posttransplantation mortality in both groups. The rate of Impella-related complications for patients receiving short-term and prolonged Impella 5.5 support was comparable between the 2 groups except for bleeding and ventricular tachyarrhythmia, which occurred more frequently in prolonged group (P < .05).

Prolonged Impella 5.5 support was associated with comparable waitlist mortality and greater device-related complications. Our data suggest that prolonged Impella 5.5 support is a viable strategy for bridge to heart transplantation.