Bridging with Surgically Placed Microaxial Left Ventricular Assist Devices: A High-Volume Center Experience

Abstract Objectives The Impella 5.0 and 5.5 have largely superseded non-ambulatory temporary mechanical support devices, yet clinical outcomes are predominantly limited to small series: this study presents the experience of a high-volume center. Methods An institutional clinical registry was used to identify all patients with cardiogenic shock who underwent Impella 5.0 or 5.5 implantation from January 2014 through March 2022. The primary outcome was survival to device explantation. Results The study cohort comprised 221 patients, including 146 (66.1%) Impella 5.0 and 75 (33.9%) Impella 5.5 patients. The primary etiology was non-ischaemic cardiomyopathy (50.7%, n = 112), ischaemic cardiomyopathy (23.1%, n = 51), and acute myocardial infarction (26.2%, n = 58). Patients were prospectively classified according to strategy as bridge to transplant (47.5%, n = 105), bridge to durable device (13.6%, n = 30) or bridge to recovery (38.9%, n = 86). Patients were predominantly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2 (95.0%, n = 210). The median bridging duration was 14 (range 0–137) days. Device exchange, Ischaemic stroke, and ipsilateral arm ischaemia occurred in 8.1% (n = 18), 2.7% (n = 6) and 1.8% (n = 4) of patients, respectively. Compared to the 75 most recent Impella 5.0 patients, Impella 5.5 patients (n = 75) had lower rates of device exchange (4.0%, n = 3 versus 13.3%, n = 10, p = 0.04). Overall, 70.1% (n = 155) of patients survived to Impella explantation. Conclusions The Impella 5.0 and 5.5 provide safe and effective temporary mechanical support in appropriately selected patients with cardiogenic shock. The newer device generation may have a lower requirement for device exchange as compared to its predecessor.