Impella 5.5 as Heart Transplant Bridge Facilitated Rehabilitation and Improves Post-Transplant Outcomes: Retrospective Cohort Study
Sadhana Jonna, Gustavo Olaizola, Lekhya Raavi, Iván Huespe, Susana Bauque, Anek Jena, Aayushi Pareek, Said Bateh, Abby Hanson, Alicia González Pérez, Shahin Isha, John C. Haney, Penny Amoroso, Sara Vilela, KIMBERLY BRITTON, Nikki Matos, Michelle Ojard, Sean Kiley, Rachel Hannon, Juan Leoni, Melissa Lyle, Mathew Thomas, Başar Sareyyüpoğlu, Lydia Sura, Olivia Davis, Si M. Pham, Greg Worsowicz, Parag C. Patel, Pablo Moreno Franco, Devang Sanghavi
Abstract
Heart transplantation is a well-established treatment for end-stage heart failure, but many patients present in poor physical condition, complicating outcomes. The Impella 5.5 device, used in cardiogenic shock, may support pretransplant rehabilitation by stabilizing organ function and promoting functional improvement. This retrospective cohort study assessed the relationship between functional status, measured by standardized Activity Measure for Post-Acute Care Basic Mobility (AM-PAC) scores, and days alive outside the hospital within 30 days post-transplant (DAOH-30). Patients who received Impella 5.5 support before transplantation between January 2019 and October 2023 were included, excluding those without AM-PAC scores within 24 hours pretransplant. Among 65 patients, the median DAOH-30 was 15 days (interquartile range [IQR], 8-19). Higher pretransplant standardized AM-PAC scores correlate with increased DAOH-30 (adjusted coefficient 0.3; 95% confidence interval [CI] = 0.01-0.6; p = 0.04), as did AM-PAC score improvement during rehabilitation (adjusted coefficient 0.35; 95% CI = 0.01-0.6; p = 0.04). Extended rehabilitation was associated with greater functional gains. These findings suggest that better pretransplant functional status and rehabilitation-related improvements were associated with increased DAOH-30. The Impella 5.5 device facilitates rehabilitation and may enhance post-transplant outcomes. Further research should refine strategies to optimize rehabilitation and recovery in this high-risk population.