Impella 5.5 Support as Bridge to Recovery vs. Heart Replacement Therapy: Outcomes 6 Months After Explant

All articles of this category (opens in new window) Background: Driven by demographic aging, the prevalence of heart failure and cardiogenic shock (CS) is rising, increasing demand for advanced support. The Impella 5.5, a high-flow micro-axial flow pump, has emerged as an adaptable temporary option to stabilize CS. Left ventricular unloading enables early extubation and mobilization in many centers and is associated with improved perfusion, supporting end-organ recovery and allowing time to select the definitive strategy. The axillary implantation route permits sustained support and ambulation, making the device well-suited for bridging either to native heart recovery (NHR) or to heart replacement therapy (HRT: LVAD or heart transplantation). Despite growing increasing clinical adoption, robust evidence on mid-term, pathway-specific outcomes with Impella 5.5 in routine care remains limited. The primary aim of this study was to evaluate 6-month postexplant survival in patients bridged either to recovery or to HRT. To our knowledge, such an analysis has not previously been reported in European real-world practice. Methods: We performed a retrospective single-center cohort study of consecutive adults with CS supported by Impella 5.5 between January 2023 and March 2025. The primary endpoint was 6-month survival post-Impella 5.5 explant in patients bridged either to NHR or to HRT (LVAD or HTX), and as a secondary outcome, postexplant survival n = 54. Survival was estimated by Kaplan–Meier with log log-rank test across pathways. One-way ANOVA and Kruskal–Wallis test compared baseline characteristics between the three groups. Results: Of 54 patients, 36 survived to explant, and 18 died on Impella (66.67% vs. 33.33%), median age 51 (28–60) years in HTX, 64 (54–69) years in LVAD, and 61 (50–68) years in NHR ( p = 0.06). With comparable Impella 5.5 support duration (14 ± 10 days vs. 16 ± 8 days vs. 12 ± 5 days, p = 0.58). Kaplan–Meier curves showed comparable results, with a trend toward the highest survival after transplantation, intermediate with LVAD, and lowest with NHR ( p = 0.210). At 6 months postexplant, survival was 100% after HTX (8/8), 77.8% after LVAD (7/9), and 68.4% with NHR (13/19), resulting in an overall survival rate of 77.8% (28/36) among patients explanted alive. Conclusion: In a higher volume program, Impella 5.5 enabled explant in two-thirds of CS patients and supported both NHR and HRT. Six-month outcomes postexplant showed a comparable result between the three groups. These findings support Impella 5.5 as a practical bridge in CS and call for prospective studies to refine selection and timing. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany