Extended Support With an Impella 5.5: Single-Center Experience and Outcomes

Prolonged use of the Impella 5.5 is becoming increasingly common in patients requiring temporary mechanical circulatory support, yet its association with mortality and neurologic outcomes remains uncertain. We evaluated whether prolonged Impella 5.5 support was independently associated with adverse clinical outcomes at a tertiary center.

We retrospectively studied adults who underwent Impella 5.5 implantation between January 2022 and December 2025. Patients receiving intraoperative support or concomitant extracorporeal membrane oxygenation with Impella were excluded. Prolonged support was defined as duration exceeding the third quartile (> 27 days). The primary outcome was in-hospital mortality. The secondary outcome was unfavorable neurologic outcome at discharge, defined as modified Rankin Scale > 0, with death assigned a score of 6. Multivariable logistic regression adjusted for body mass index (BMI) and Charlson Comorbidity Index (CCI).

Among 129 patients (median age 61 years, 74.4% male), median support duration was 15 days. Overall, in-hospital mortality was 21.7%, and unfavorable neurologic outcome occurred in 36.5% of patients. Patients requiring prolonged support had greater comorbidity burden (CCI 3 vs. 2, p = 0.007) and longer intensive care unit (55.59 vs. 25.47 days, p < 0.001) and hospital (78.5 vs. 44.0 days, p < 0.001) stays. However, prolonged support was not independently associated with in-hospital mortality (aOR: 2.16, 95% CI: 0.69-6.54, p = 0.174) or unfavorable neurologic outcome (aOR: 1.58, 95% CI: 0.64-3.90, p = 0.321).

Prolonged Impella 5.5 support was associated with greater resource utilization but was not significantly associated with adjusted mortality or adverse neurologic outcomes in this cohort.