Improved Clinical Outcomes Associated with the Impella 5.5 Compared to the Impella 5.0 in Contemporary Cardiogenic Shock and Heart Failure Patients

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; p. S31
• Main Authors: Ramzy, D., Soltesz, E.G., Silvestry, S.C., Hall, S.A., D'Alessandro, D.A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.068

To compare outcomes in patients treated with the surgically implanted Impella 5.5 vs Impella 5.0 heart pumps for acute myocardial infarction complicated by cardiogenic shock (AMICS), post cardiotomy cardiogenic shock (PCCS), or acute decompensated heart failure (ADHF). A retrospective analysis included all Impella 5.5 and Impella 5.0 implanted for AMICS, PCCS and ADHF between October 2019 and December 2020. The IQ registry is an FDA-mandated quality assurance database that captures baseline characteristics and outcomes through device explant. Patients receiving extracorporeal membrane oxygenation before/during Impella use were excluded. Those with aborted placement or unknown outcome were not included for assessment of clinical outcome. We examined ability to wean off support, bridge to other therapy, and duration of support. There was no significant difference in gender distribution, baseline LVEF, or pulmonary artery catheterization use in 5.5 vs. 5.0 patients. AMICS 5.5 patients were significantly younger (median 62 vs 66 years, p<0.001). Patients treated with the 5.5 had significantly higher survival in all 3 subgroups (AMICS, 70.5% vs 56.8%, p=0.005; ADHF, 88.1% vs 76.9%, p=0.001; PCCS, 76.1% vs 55.7%, p=0.003) (Table 1). Duration of support was significantly longer in AMICS 5.5 patients vs 5.0 patients (median 9.2 vs 6.1 days, p=0.008) and ADHF 5.5 patients vs 5.0 patients (median 10.7 vs 8.1 days, p<0.001). Rates of hemolysis, cerebrovascular accident, vascular injury and bleeding were statistically similar, with the exception of significantly lower hemolysis rates in cardiomyopathy patients treated with the Impella 5.5. Outcomes were significantly improved with the Impella 5.5 when compared to the Impella 5.0 across all analyzed indications in contemporary patients, though further analysis remains to determine whether this owes to the device redesign or higher flow capability.