Impella 5.5 Versus Intra-Aortic Balloon Pump for Bridging Heart Transplant Patients: A Contemporary Analysis of the United Network for Organ Sharing Database

Anecdotally, over the past 2 years, many transplant centers in the United States have shifted toward using Impella 5.5 instead of intra-aortic balloon pumps (IABP) for less sick patients. The aim of our study is to determine if Impella 5.5 devices are now used more liberally for status 2 heart transplant candidates and whether this confers any benefit to post heart transplant outcomes. We evaluated the United Network for Organ Sharing Database (UNOS) database and analyzed status 2 patients who underwent heart transplantation after being bridged with an Impella 5.5 or IABP from October 2019 to March 2024. The rate of Impella implants for supporting status 2 candidates significantly increased from 9% to 35% ( p < 0.001). More patients in the Impella cohort were on inotropic support at the time of transplant (63% vs . 58%; p = 0.013) and were more likely to have undergone previous cardiac surgery (25% vs. 20%; p = 0.04). The Impella 5.5 patients had an overall shorter length of hospital stay compared with the IABP patients (20.4 vs . 22.5 days; p = 0.05), but there was a significantly higher rate of stroke in the Impella 5.5 group (5% vs . 3%, p = 0.016). A more detailed cost-effective analysis is required to determine if the increased utilization of this device is justified based on its increased cost.