Impella 5.5 as a bridge to dual-organ transplantation

Vollständiger Abstract

Worum geht es in dieser Arbeit?

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.