Impact of Impella CP to Impella 5.0/5.5 Upgrade Prior to a Durable Left Ventricular Assist Device Implantation

Background: Microaxial flow pumps (mAFP) are effectively used to bridge cardiogenic shock patients to durable left ventricular assist device (LVAD) implantation. Percutaneously implanted Impella CP and surgical Impella 5.5 mAFPs provide 4.3 and 5.5 L/min support, respectively. In this study, we compared the outcomes of patients bridged to a durable LVAD implantation directly from Impella CP with those who underwent a switch to Impella 5.0/5.5 before.

Methods: A retrospective analysis of 130 patients from 17 European cardiac centers who underwent a durable MCS implantation from a mAFP between 02/2015 and 08/2022 was conducted. Ninety-two patients (70.8%) were bridged to a durable LVAD on Impella CP and 38 (19.2%) underwent a mAFP upgrade from Impella CP to 5.0/5.5.

Results: The 30-day and 1-year survival rates in the upgrade group were 89.5% (95% CI: 80.2, 99.8) and 84.2% (95% CI: 73.0, 96.6), respectively, compared with 84.7% (95% CI: 77.7, 92.4) and 63.7% (95% CI: 54.3, 74.6) in the no-upgrade group. The unadjusted restricted mean survival time (RMST) was 56.1 days longer in the upgrade group (312.2 days [95% CI: 272.7, 351.8] versus 256.4 days [95% CI: 224.9, 287.8]), with p = 0.030. A higher incidence of postoperative liver dysfunction was observed in the no-upgrade group (33.7% versus 7.9%, p = 0.027), while the incidences of stroke, renal replacement therapy, and bleeding were comparable between the groups. Adjusted RMSTs were similar between the two groups, with a difference of −40.8 days (95% CI: −99.8, 47.3) between patients without an upgrade to 5+ (257.1 days [95% CI: 223.6, 290.7]) and those with an upgrade (297.9 days [95% CI: 224.1, 371.8]) (p = 0.263).

Conclusion: In patients with cardiogenic shock supported by an Impella CP microaxial flow pump, an upgrade to the Impella 5+ device before durable LVAD implantation may be associated with improved survival. Those undergoing the upgrade also experienced lower rates of postoperative liver dysfunction, which was linked to a significantly increased risk of 30-day mortality. Prospective randomized studies are needed to further demonstrate the benefits of the Impella upgrade strategy.

Publication History

Article published online:
11 February 2025