Key result
Impella shows similar 1-year mortality to IABP before heart transplantation but increases post-transplant stroke risk.
Why the study?
Practice has shifted toward greater use of surgically implanted Impella microaxial pumps over IABP as temporary mechanical circulatory support for Status 2 advanced heart failure patients awaiting heart transplantation, yet comparative post-transplant outcomes remained uncertain.
Does temporary mechanical circulatory support with Impella microaxial pumps improve post-transplant outcomes compared with intra-aortic balloon pump in adult Status 2 advanced heart failure patients awaiting heart transplantation?
Meta-Analysis (n=15,872)
Does temporary mechanical circulatory support with Impella microaxial pumps improve post-transplant outcomes compared with intra-aortic balloon pump in adult Status 2 advanced heart failure patients awaiting heart transplantation?
In Status 2 heart transplant candidates, bridging with Impella showed no mortality or graft-survival advantage over IABP while increasing peri-transplant support requirements and post-transplant stroke risk.
Background Temporary mechanical circulatory support (tMCS) is frequently required to stabilise advanced heart failure patients (AHF) awaiting heart transplantation (HTx) under Status 2 criteria. Contemporary practice has shifted towards greater use of surgically implanted microaxial pumps (Impella CP, 5.0, or 5.5) compared with intra-aortic balloon pump (IABP), yet comparative post-transplant outcomes remain uncertain. Purpose This study aimed to compare post-transplant outcomes in patients with AHF awaiting heart transplantation who received either Impella microaxial pumps or IABP as temporary mechanical circulatory support until the transplant. Methods PubMed, Embase, and Cochrane were systematically searched. We included studies comparing Impella versus IABP as a bridge-to-transplant in adult Status 2 candidates and pooled effect estimates using random-effects models. Across the provided eligible studies, 15,872 transplanted recipients were analysed. Results Compared with IABP, Impella support was associated with similar 1-year mortality (RR 0.49 [95% CI 0.05–4.66], P=0.53), short-term mortality (RR 1.66 [95% CI 0.46–5.94], P=0.4344), acute rejection (RR 1.23 [95% CI 0.65–2.32], P=0.52), first graft dysfunction (RR 1.08 [95% CI 0.70–1.66], P=0.73), dialysis post-transplant (RR 0.91 [95% CI 0.73–1.13], P=0.40), length of hospital stay (MD −0.05 days [95% CI −1.92 to 1.82], P=0.95), and bleeding at insertion (RR 2.84 [95% CI 0.61–13.20], P=0.16), with lower chronic rejection (RR 0.95 [95% CI 0.91–1.00], P=0.03) but higher post-transplant stroke risk (RR 1.64 [95% CI 1.18–2.28], P=0.003); Impella use was also associated with longer duration of mechanical circulatory support (MD 9.31 days [95% CI 2.34–16.27], P=0.008), greater need for mechanical ventilation at transplantation (RR 1.31 [95% CI 1.04–1.65], P=0.01), and nonsignificant trends towards longer waiting list time (MD 2.20 days [95% CI −0.07 to 4.47], P=0.05) and higher inotrope use at transplant (RR 1.09 [95% CI 0.98–1.21], P=0.09). Conclusions Compared with IABP, Impella support showed no clear mortality or graft-survival advantage and was associated with greater peri-transplant support requirements and higher post-transplant stroke risk.
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Montenegro et al. (2026) conducted a meta-analysis in Advanced heart failure awaiting heart transplantation under Status 2 criteria (n=15,872). Impella microaxial pump (CP, 5.0, or 5.5) vs. Intra-aortic balloon pump (IABP) was evaluated on 1-year mortality (RR 0.49, 95% CI 0.05-4.66, p=0.53). Impella support had similar 1-year mortality vs IABP (RR 0.49, 95% CI 0.05–4.66; P=0.53) and higher post-transplant stroke risk (RR 1.64, 95% CI 1.18–2.28; P=0.003).
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