Acute antibody-mediated cardiac allograft rejection (AMR) can lead to SCAI Stage D cardiogenic shock, frequently necessitating escalation to extracorporeal membrane oxygenation support. However, biventricular Impella (BiPella), configured with Impella 5.5 and Impella RP Flex, may offer an alternative, less invasive cardiac unloading and support. We present a 28-year-old male nine-months post-heart transplantation who developed refractory shock from AMR after immunosuppression nonadherence. Hemodynamic instability and elevated filling pressures prompted emergent initiation of simultaneous Impella 5.5 and Impella RP Flex support. Over two weeks, cardiac function improved significantly for BiPella removal and discharge. In select patients, BiPella may serve as a less invasive alternative to venoarterial extracorporeal membrane oxygenation support in rejection-associated biventricular failure, with potential advantages for substantial ventricular unloading, early mobilization, and bridging to recovery.
Kwon et al. (Fri,) studied this question.