Impella 5.5 Support in Severe Cardiogenic Shock: Outcomes From the First Spanish Multicentre Cohort in Heart Transplant Centres

Abstract

OBJECTIVES: Impella 5.5 is an established temporary mechanical circulatory support (tMCS) device for severe cardiogenic shock. Spain, characterized by high heart transplant activity and increasing use of controlled donation after circulatory death (DCD), provides a relevant setting to evaluate its use and outcomes. We aimed to describe clinical characteristics, trajectories, and outcomes of Impella 5.5 support in the first Spanish multicentre cohort from heart transplant centres. METHODS: Retrospective multicentre observational study including consecutive patients supported with Impella 5.5 in hospitals with active heart transplant programmes. Baseline characteristics, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, additional support, complications, support duration, and in-hospital mortality were recorded. Outcomes were analysed across INTERMACS profiles. RESULTS: Ninety-three patients were included (33 INTERMACS 1, 37 INTERMACS 2, 23 INTERMACS 3). Additional support was required in 46%, mainly venoarterial extracorporeal life support (VA-ECLS). Device-related complications were reported as event frequencies. The predominant clinical trajectory was heart transplantation (68.8%), contrasting with international series in which long-term mechanical support and transplantation are more evenly distributed. In-hospital mortality was 43%, with a clear gradient across INTERMACS profiles 1-3 (60.6%, 37.8%, and 26.1%, respectively; P = .013). Mean support duration was 16 days, and more than one-third of transplants were from controlled DCD donors. CONCLUSIONS: Impella 5.5 was used as tMCS in severe cardiogenic shock and was predominantly associated with heart transplantation in a transplant-oriented healthcare system. Outcomes were closely associated with INTERMACS profile, reflecting differences in baseline severity and patient selection. Comparisons with international registries are descriptive only.