Pushing the Boundaries: Prolonged Impella 5.5 Support as a Bridge to Definitive Advanced Heart Failure Therapy

All articles of this category (opens in new window) Background: Given the long waiting times for heart transplantation (HTX), prolonged Impella 5.5 support is being increasingly utilized as a bridging strategy. We evaluated the safety and outcomes of Impella 5.5 support beyond 30 days as a bridge to definitive advanced heart failure therapy. Methods: Since 2023, 43 patients underwent Impella 5.5 implantation for cardiogenic shock at our center. Eight patients received prolonged support > 30 days as a bridge-to-HTX or durable mechanical circulatory support (dMCS). Herein, we describe the outcomes of these patients. Results: Six patients were male, and the mean age was 40.9 ± 19.6 years. The underlying diagnosis was dilated cardiomyopathy in four patients, ischemic cardiomyopathy in three patients, and acute myocardial infarction in one patient. Two patients were Intermacs 1, and six patients were Intermacs 2. All implantations were performed through subclavian access, and five patients underwent awake implantation. The attempted bridging strategy was bridge-to-HTX in six patients, bridge-to-LVAD in one patient, and bridge-to-decision in one patient. After implantation, seven patients achieved ambulation within a week. Device-related complications include surgical wound revision in one patient, subclinical stroke in one patient, BARC Scale > 2 bleeding events in four patients, and device thrombosis in two patients. In the first patient, thrombosis of the purge system occurred on day 40 (solved with low-dose lysis). The second patient experienced thrombosis of the purge system on day 12 and pump thrombosis with pump failure on day 35 (pump exchange was required both times). After a mean support duration of 50.6 ± 18.3 days (34–89 days), four patients were bridged to HTX, and four patients underwent dMCS implantation. After Impella explantation, two patients required surgical thrombectomy due to thrombotic occlusion of the ipsilateral axillary artery. Intrahospital death occurred in two patients due to primary graft failure after HTX and multiorgan failure after dMCS implantation. Follow-up times after hospital discharge range between 35 and 457 days. No deaths occurred during follow-up. Conclusion: Prolonged Impella 5.5 support as a bridging strategy enables early physical rehabilitation, and clinical outcomes are promising. However, device-related complications pose an ongoing clinical concern and require further investigation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany