Reconsidering FDA Guidelines: A Single-Center Experience of Prolonged Impella 5.5 Support

Abstract

Objective: Impella 5.5 (Abiomed, Danvers, MA, USA) is approved by the US Food and Drug Administration (FDA) for mechanical circulatory support for ≤14 days. It is unknown whether prolonged support is associated with worse outcomes. We sought to review our single-center experience with Impella 5.5 and compare outcomes based on support duration. Methods: We retrospectively reviewed adult patients (≥18 years old) supported with Impella 5.5 at our institution (May 2020 to April 2023). Patients on prolonged support (>14 days) were compared with those supported for ≤14 days. Results: There were 31 patients supported with Impella 5.5 including 14 (45.2%) supported >14 days. Median support duration for those on prolonged support was 43.5 (interquartile range [IQR] 25 to 63.5) days versus 8 (IQR 6, 13) days for those who were not ( P < 0.001). Overall, the device-related complication rate was 9.7% and did not differ between groups ( P = 0.08). Overall, 30-day postimplant survival was 71% and did not differ by support duration ( P = 0.2). In-hospital mortality was 32% and did not differ between cohorts ( P > 0.99). Among those surviving to explant ( n = 22), long-term strategy included bridge to durable ventricular assist device (18%, n = 4), cardiac transplant (55%, n = 12), and cardiac recovery (27%, n = 6). Conclusions: High-risk patients with cardiogenic shock may be supported with Impella 5.5 beyond the FDA-approved duration without increased risk of complications or mortality.