Key result
Impella 5.5 placement significantly reduced mean pulmonary artery pressures from 38.2 to 27 mmHg (p=0.004) and improved cardiac index, serving as a successful bridge to orthotopic heart transplant.
Why the study?
Pulmonary hypertension in end-stage heart failure from amyloid cardiomyopathy can contraindicate heart transplantation and is challenging to manage with conventional therapies.
Does temporary mechanical circulatory support with Impella 5.5 improve pulmonary artery pressures and cardiac index to successfully bridge patients with amyloid cardiomyopathy to orthotopic heart transplantation?
Observational (n=5)
No
Does temporary mechanical circulatory support with Impella 5.5 improve pulmonary artery pressures and cardiac index to successfully bridge patients with amyloid cardiomyopathy to orthotopic heart transplantation?
Temporary mechanical circulatory support with Impella 5.5 is a feasible and effective strategy to lower severe pulmonary hypertension and improve hemodynamics, successfully bridging select patients with amyloid cardiomyopathy to heart transplantation.
Answers are grounded in this paper and cite their sources.
May support Impella 5.5 bridging in select amyloid cardiomyopathy cases with pulmonary hypertension; hypothesis-generating and requires prospective validation.
Abstract Purpose The definitive treatment for end-stage heart failure (ESHF) due to amyloid cardiomyopathy (ACM) is an orthotopic heart transplant (OHT). However, associated pulmonary hypertension (PH) can present as a contraindication to OHT and be challenging to manage with conventional therapies. We herein reported the successful use of Impella 5.5 in a series of patients with ACM to improve PH and successfully bridge to OHT. Methods Five patients with ACM associated ESHF were analyzed. All patients had moderate to severe PH on admission. As a bridge to transplant, Impella 5.5 was inserted through the axillary artery, and continued until OHT. Results All patients were male, and mean age was 62.2±1.3 years. One patient had light chain associated amyloid cardiomyopathy (AL-CM), two had wild-type transthyretin associated amyloid cardiomyopathy (ATTRwt-CM), and two had variant transthyretin amyloid cardiomyopathy (ATTRv-CM). Indication for Impella 5.5 was to support acute on chronic heart failure and improve elevated PA pressures. Mean support time was 34.4±11.97days. Mean PA pressures decreased from 38.2±4.43mmHg to 27±4.24mmHg, and cardiac index increased from 1.58±0.44L/min/m² to 2.46±0.43L/min/m². No major adverse events related to Impella insertion occurred. All patients were successfully transplanted and doing well after OHT with no mortality after a mean follow-up of 13±10.88 months. Conclusion Bridging patients with ACM to OHT remains challenging due to small left ventricular cavity and associated PH. Temporary mechanical circulatory support with Impella 5.5 helps reduce PA pressures and improve cardiac index, making Impella 5.5 can be safe and feasible option to bridge patients with ACM to OHT.
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Garg et al. (2025) conducted an observational in Amyloid cardiomyopathy with end-stage heart failure (n=5). Impella 5.5 vs. Baseline (Pre-Impella) was evaluated on Mean pulmonary artery pressure (mmHg) (decrease of 11.2 mmHg, p=0.004). Impella 5.5 placement significantly reduced mean pulmonary artery pressures from 38.2 to 27 mmHg (p=0.004) and improved cardiac index, serving as a successful bridge to orthotopic heart transplant.
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