Key result
Low baseline cardiac power output shows similar ambulation rates on Impella 5.5 before transplantation.
Why the study?
Whether patients with severely reduced baseline cardiac power output can achieve meaningful ambulation during Impella 5.5 support as a bridge to heart transplantation remains uncertain.
Does baseline cardiac power output affect the ability to achieve functional recovery and ambulation during Impella 5.5 support in heart transplant candidates with cardiogenic shock?
Observational (n=80)
Does baseline cardiac power output affect the ability to achieve functional recovery and ambulation during Impella 5.5 support in heart transplant candidates with cardiogenic shock?
Active prehabilitation and ambulation are highly feasible in heart transplant candidates supported with an Impella 5.5 device, even among those with severely compromised baseline cardiac power output.
Ambulation appears feasible during Impella 5.5 support even with low baseline CPO; leaves open effects on transplant outcomes in cardiogenic shock.
BACKGROUND: The Impella 5.5 microaxial pump facilitates ambulatory mechanical circulatory support via axillary implantation, providing a model for active prehabilitation in critically ill heart transplant candidates. Whether patients with severely reduced baseline cardiac power output (CPO) can achieve meaningful ambulation during Impella 5.5 support remains uncertain. METHODS: This is a retrospective descriptive study of consecutive adults with cardiogenic shock (SCAI stages C-E) who received an Impella 5.5 as a bridge to heart transplantation between April 2022 and September 2024. Cardiac Power Output was calculated via pre-implantation right heart catheterization, defined as low (≤0.60 W) or higher (>0.60 W). Measures of functional recovery include maximum walking distance per day, cumulative walking distance during Impella 5.5 support, time to first walk, and percentage of patients who walked at least once. The LOWESS method is used to illustrate overall walking distance trajectories. RESULTS: The final analytic cohort included 80 patients: 37 (46.3%) with baseline CPO ≤0.60 W and 43 (53.8%) with baseline CPO >0.60 W. Overall, 75 of 80 patients (93.8%) ambulated at least once before transplantation, including 89.2% in the low-CPO group and 97.7% in the higher-CPO group (p = 0.176). The time to first walking day was 5 days (IQR 3-7) in the low-CPO group vs. 3 days (IQR 2-7) in the higher-CPO group (p = 0.27). Maximum daily walking distance was 5,200 ft (IQR 2,000-10,400 ft) vs. 4,000 ft (IQR 2,400-8,000 ft) (p = 0.26), while cumulative distance was 15,400 ft vs. 11,000 ft (p = 0.81). CONCLUSIONS: Prehabilitation is feasible in patients undergoing Impella 5.5 support across the spectrum of hemodynamic status. Patients with severely compromised baseline cardiac performance achieved early, substantial ambulation. Thus, Impella 5.5 appears feasible as a platform for both hemodynamic support and prehabilitation of patients awaiting heart transplantation, though larger, non-selected cohorts are needed to confirm these findings.
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Patel et al. (2026) conducted an observational in Cardiogenic shock in heart transplant candidates (n=80). Low baseline Cardiac Power Output (≤0.60 W) vs. Higher baseline Cardiac Power Output (>0.60 W) was evaluated on Ambulated at least once before transplantation (p=0.176). Among heart transplant candidates on Impella 5.5, those with low baseline cardiac power output achieved similar rates of ambulation compared to those with higher output (89.2% vs 97.7%, P=0.176).
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