Article

A4 - Use of a Percutaneous Temporary Mechanical Circulatory Support as a Bridge to Decision in Advanced Heart Failure Patients Listed for Heart Transplantation

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Correspondence: Alexis Okoh, disciple951@gmail.com

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Background: The Impella is a minimally invasive axial-flow catheter capable of providing full temporary haemodynamic support (THS). We report on a national series on the use of this device for bridge to decision (BTD) in patients listed for heart transplantation.

Hypothesis: We hypothesised that, among patients listed for heart transplantation, the Impella can be used as a BTD strategy during acute haemodynamic decompensation.

Methods: The United Network for Organ Sharing Database was queried to identify all patients who had an Impella placed for THS while listed for heart transplantation between 2008 and 2018. We analysed demographics, procedural characteristics and intermediate outcomes. Among patients who were transplanted, 1-year post-transplant survival was compared between those directly bridged to transplant with an Impella, transitioned to a durable mechanical circulatory support (MCS) or had the device explanted before transplant.

Results: Between 2008 and 2018, 349 patients were implanted with Impella 2.5 (n=81), Impella 5.0 (n=262) or Impella CP (n=6) for THS while on the waiting list. The median age was 54 years (interquartile range 37–61 years) and 74.5% (n=260) were men. The aetiology of cardiomyopathy was ischaemic in 26% (n=90). The mean duration of support was 8 days (range 0–25 days). Of the patients, 72% (n=252) survived to next therapy and 73% (n=185) reached transplant. Among those who reached transplant, 130 (70%) were bridged directly with an Impella, 15% (n=27) with a durable MCS and 15% (n=28) had the device explanted before heart transplantation. Survival at 1-year post-transplant for the three groups was 89% versus 81% versus 90%, respectively (log-rank test: p=0.212).

Conclusion: The Impella percutaneous MCS may provide a BTD strategy for patients with advanced HF and acute haemodynamic instability while on the transplant list. Post-transplant survival is similar, irrespective of bridging strategy. Prospective studies are needed to evaluate the safety and effectiveness of this device in this patient population.