Repeat Impella 5.5 During Single Hospitalization: A Single Center Experience

The Impella 5.5 device is a temporary mechanical circulatory support device widely used in patients with refractory cardiogenic shock. However, device-related or device-associated complications, as well as recurrent cardiogenic shock after device removal, may necessitate repeat implantation during the same hospitalization.

Out of 579 who underwent Impella 5.5 implantation at our institution between January 2020 and 2026, we reviewed the 14 patients who required repeated insertion during a single hospitalization. Indications for repeat implantation were categorized as device-related failure or physiologic deterioration. The primary outcome was survival to hospital discharge. Secondary outcomes included stroke, surgical-site infection, and access-site bleeding.

Patients had a median age of 57 years, and 79% were male. Indications for repeat implantation were device-related failure in 57% (8/14) and physiologic deterioration in 43% (6/14). Median interval between devices was 10.5 days (IQR, 6-22). Repeat implantation was performed through the same axillary access site in 57% (8/14) and a new access site in 43% (6/14). After initial device insertion, 50% required VA-ECMO and 28%. Survival to hospital discharge was 71% (10/14); however, post-reimplantation complications were frequent, with stroke and access-site bleeding each occurring in 29% of patients and surgical-site infection in 7%. Five patients (36%) underwent durable LVAD implantation and 5 (36%) underwent heart or heart-kidney transplantation.

Repeat Impella 5.5 implantation during a single hospitalization was uncommon and was performed in a highly selected cohort with favorable survival outcomes, although accompanied by a substantial rate of neurological and local bleeding complications. These descriptive findings should be interpreted in the context of substantial selection bias, small sample size, and single-center experience.