Impella 5.5 as a bridge to dual-organ transplantation

The Impella 5.5 is increasingly utilized as temporary mechanical circulatory support to bridge patients in cardiogenic shock to heart transplantation. Patients listed for dual-organ transplantation may experience longer wait times than heart transplant alone. We aimed to evaluate the feasibility of Impella 5.5 as a bridge to dual-organ transplant. We performed a retrospective review of patients with cardiogenic shock supported with Impella 5.5 who subsequently underwent heart transplant or dual-organ transplant from 2021 to 2025. Dual-organ transplant included combined heart-kidney, heart-liver, and heart-lung transplants. Fifty-four total patients received Impella 5.5 bridge, for which six were dual-organ transplants. Blood type A was most common among both groups (heart transplant 39.6%, dual-organ transplant 66.7%). Median ages were 56 (IQR 46.5-61.2) for isolated heart transplants and 57.5 (IQR 37.5-62) years old for dual-organ transplants. All patients were SCAI class C or higher. Non-ischemic cardiomyopathy was the predominant etiology (heart transplant 100%, dual-organ transplant 83%). Dual organ transplant recipients underwent heart-kidney (n = 3), heart-lung (n = 1), or heart-liver (n = 2) transplants, with median Impella 5.5 support durations of 117, 19, and 42 days, respectively. This is compared to a median support duration of 14 days for isolated heart transplant recipients. Detailed baseline characteristics and post-transplant outcomes were similar across subgroups. Use of Impella 5.5 as a bridge to dual-organ transplants is feasible and safe in selected patients with cardiogenic shock with multi-organ failure. Further studies are needed to assess laboratory data, hemodynamics trajectories, and long-term survival outcomes in this population.