Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 1;71(4):300-307.
doi: 10.1097/MAT.0000000000002331. Epub 2024 Oct 14.

Hemodynamic Support With the Impella 5.5 Acute Mechanical Circulatory Support Device

James W Schurr  1 , Adrian Pearson  1 , Matthew S Delfiner  1 , Alyson Brown  1 , Mary Frances Quinn  2 , Yoav Karpenshif  1 , Juan Ortega-Legaspi  1 , Aditya Parikh  1 , Marisa Cevasco  3 , Joyce W Wald  1
Affiliations

Hemodynamic Support With the Impella 5.5 Acute Mechanical Circulatory Support Device

James W Schurr et al. ASAIO J. .

Abstract

The Impella 5.5 is increasingly used as a bridge to recovery or heart replacement therapies despite lack of clinical trial evidence. We report real-world outcomes and hemodynamic effects of 150 consecutive patients from a single, high-volume center. Primary outcome was incidence of recovery, durable left ventricular assist device (LVAD), or heart transplant compared with incidence of death at 90 days. Secondary outcomes included hemodynamic trends and upgrade to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. The composite endpoint occurred in 59.3% and death in 18.8% of patients (incidence rate ratio: 8.1 [95% confidence interval {CI}: 5.4-12.2], p < 0.001). Decreases in pulmonary artery diastolic pressure (PADP) ( p = 0.026), estimated pulmonary effective arterial elastance (Ea) ( p < 0.001), and vasoactive-inotropic score (VIS) ( p < 0.001) occurred during Impella 5.5 support. Pulmonary artery diastolic pressure correlated with estimated Ea ( p < 0.001), suggesting improved right ventricle (RV) afterload with left ventricle (LV) unloading. Veno-arterial extracorporeal membrane oxygenation upgrade occurred in 11.3% of patients who had higher baseline right atrial pressure (RAP) (16.0 [9.0-20.5] vs. 9.0 [7.0-12.0], p = 0.022), PADP (28.5 [25.0-31.0] vs. 23.0 [18.0-28.0], p = 0.011), and lower pulmonary artery pulsatility index (PAPi) (1.45 [0.82-3.45] vs. 2.5 [1.65-3.86], p = 0.029). Upgrade patients had higher repeated measures trends in RAP ( p < 0.001) and PADP ( p = 0.015). The Impella 5.5 improved hemodynamics and effectively bridged to recovery or heart replacement therapies. Co-existing RV dysfunction can be supported on Impella 5.5 with careful hemodynamic trend monitoring.

PubMed Disclaimer

Conflict of interest statement

Disclosure: J.O.-L. served as a consultant for Impulse Dynamics, M.C. was a consultant for Abiomed, and J.W.W. participated in the advisory board for Boston Scientific, was part of the speakers bureau for Impulse Dynamics, and received research support from Abiomed. The other authors have no conflicts of interest to report.

References

    1. Uriel N, Sayer G, Annamalai S, Kapur NK, Burkhoff D: Mechanical unloading in heart failure. J Am Coll Cardiol. 72: 569–580, 2018.
    1. Ramzy D, Soltesz EG, Silvestry S, Daneshmand M, Kanwar M, D’Alessandro DA: Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients. J Heart Lung Transplant. 42: 553–557, 2023.
    1. Kelly RP, Ting CT, Yang TM, et al.: Effective arterial elastance as index of arterial vascular load in humans. Circulation. 86: 513–521, 1992.
    1. Tello K, Richter MJ, Axmann J, et al.: More on single-beat estimation of right ventriculoarterial coupling in pulmonary arterial hypertension. Am J Respir Crit Care Med. 198: 816–818, 2018.
    1. Koponen T, Karttunen J, Musialowicz T, Pietilainen L, Uusaro A, Lahtinen P: Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth. 122: 428–436, 2019.