Key result
Transinnominate Impella 5.5 successfully bridges failing Fontan circulation to heart transplantation with ~4.5 L/min support.
Why the study?
The Impella 5.5 supports refractory heart failure, but small peripheral arteries and atypical right ventricular anatomy may preclude its use in patients with Fontan circulation.
Case Report (n=1)
No
This case report demonstrates the feasibility of transinnominate Impella 5.5 placement as an effective bridge to heart transplantation in an adult with failing Fontan circulation, a systemic right ventricle, and small peripheral vessels.
Answers are grounded in this paper and cite their sources.
Supports transinnominate Impella access in failing Fontan; leaves open reproducibility and optimal selection in larger cohorts.
BACKGROUND: The Impella 5.5 is a temporary microaxial ventricular assist device indicated to unload the left ventricle and support refractory heart failure. Small peripheral arteries and atypical right ventricular anatomy may preclude its use in patients with Fontan circulation. CASE SUMMARY: We report a 23-year-old man with hypoplastic left heart syndrome palliated to Fontan with refractory heart failure. Impella 5.5 was placed via the innominate artery, providing 4.5 L/min support for 13 days until heart transplantation; he was discharged in good condition. DISCUSSION: Transinnominate approach enables effective bridge to transplantation despite small peripheral vessels. NOVELTY: This is the first reported case of Impella 5.5 as a bridge to transplant placed via transinnominate artery in an adult with failing Fontan circulation and a systemic right ventricle. TAKE-HOME MESSAGE: Impella 5.5 via transinnominate access is feasible in select patients with Fontan circulation and small peripheral vessels and serves as an effective bridge to transplantation.
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Okamura et al. (2026) conducted a case report in Hypoplastic left heart syndrome palliated to Fontan with refractory heart failure (n=1). Transinnominate Impella 5.5 microaxial flow pump placement was evaluated on Successful bridge to heart transplantation. Transinnominate Impella 5.5 placement provided 4.5 L/min of circulatory support for 13 days as an effective bridge to heart transplantation in a 23-year-old man with failing Fontan circulation.
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