Heparin-Induced Thrombocytopenia and Thrombosis with Axillary Impella 5.5 as Bridge-to-Transplant

Pinnelas, Rebecca; Cole, R.; Megna, D.; Lorber, Jonathan; Ramzy, Danny; Emerson, Dominic; Benck, Lillian; Sedrak, Sara; Czer, L.; Chang, D.; Esmailian, F.; Kobashigawa, J.A.; Moriguchi, J.

doi:10.1016/j.healun.2021.01.2113

Cited by 2 publications

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“…Studies have evaluated the risk of these patterns of complications in patients supported with Impella and have shown an association between Impella support and HIT and sepsis. [3][4][5] Our case report corroborates the findings of the reported case series. 1 While our collective findings do demonstrate the efficacy of Impella 5.5 support for prolonged temporary Disclosure: The authors have no conflicts of interest to report.…”

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confidence: 88%

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Efficacy of Prolonged Impella 5.5 Support as Bridge to Heart Transplantation: Current Concepts and Future Direction

2023

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1 recently published an interesting article titled, "Impella 5.5 Support beyond 50 Days as Bridge to Heart Transplant in End-Stage Heart Failure Patients" that demonstrated efficacy of the Impella 5.5 regarding its ability to provide adequate prolonged hemodynamic support and maintain durability in four cases. The four patients presented in cardiogenic shock with a history of heart failure with or without chronic kidney disease. Due to contraindications to left ventricular assist device use, they received Impella 5.5 support for a mean duration of 70 days (range 54-83). All patients were able to ambulate by day 6, with the only device malfunction being loss of placement signal in one patient and the only complication being bilateral posterior cerebral artery infarcts of unknown cause in another patient. All four patients had devices with intact pump function on explantation and underwent successful heart transplantation. The authors note only one other report in the literature of prolonged Impella 5.5 support as bridge to heart transplantation and no reports in the existing literature of malfunctions or complications in patients with prolonged use (>50 days).Adding on to their discussion of the relevant literature, we wanted to note our published experience with a patient on prolonged Impella support beyond 50 days. 2 The patient was a 51-year-old male with decompensated heart failure, chronic kidney disease, and cirrhosis who was sequentially supported with axillary intra-aortic balloon pump, Impella 5.5, and venoarterial extracorporeal membrane oxygenation (V-A ECMO) prior to triple organ, heart-liver-kidney transplantation. The patient was supported on Impella 5.5 for 79 days, comparable to the mean duration of support in the case series published by Zaky et al. 1 Total length of temporary mechanical circulatory support (MCS) was 95 days prior to successful transplantation. During the period of Impella support in our patient, he had an episode of heparin-induced thrombocytopenia (HIT) at 30 days treated with argatroban and, subsequently, sepsis at 78 days, prompting Impella explant and initiation of V-A ECMO. Studies have evaluated the risk of these patterns of complications in patients supported with Impella and have shown an association between Impella support and HIT and sepsis. [3][4][5] Our case report corroborates the findings of the reported case series. 1 While our collective findings do demonstrate the efficacy of Impella 5.5 support for prolonged temporary Disclosure: The authors have no conflicts of interest to report.

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confidence: 88%

“…Studies have evaluated the risk of these patterns of complications in patients supported with Impella and have shown an association between Impella support and HIT and sepsis. 3–5…”

Section: To the Editormentioning

confidence: 99%