Clinical outcomes of primary Impella 5.5 versus transition from extracorporeal membrane oxygenation in cardiogenic shock: A Spanish multicenter cohort.
14 affiliations
- 1Department of Cardiac Surgery, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, As Xubias, A Coruña, Spain.
- 2Grupo de investigación Cardiopatía Estructural y Congénita, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas/Universidade da Coruña (UDC), As Xubias, A Coruña, Spain.
- 3Department of Cardiovascular Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
- 4Murcian Institute for Biosanitary Research (IMIB-Arrixaca), Murcia, Spain.
- 5Department of Cardiac Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
- 6Department of Cardiac Surgery, Marqués de Valdecilla University Hospital, Santander, Spain.
- 7Department of Cardiac Surgery, Gregorio Marañón University General Hospital, Madrid, Spain.
- 8Department of Cardiac Surgery, 12 de Octubre University Hospital, Madrid, Spain.
- 9Department of Cardiac Surgery, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Madrid, Spain.
- 10Department of Cardiac Surgery, Dr. Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
- 11Department of Cardiac Surgery, Clínica Universidad de Navarra, Pamplona, Spain.
- 12Department of Cardiac Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- 13Grupo de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas/Universidade da Coruña (UDC), As Xubias, A Coruña, Spain.
- 14Department of Cardiac Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain.
Abstract
Objective
Mechanical circulatory support strategies for cardiogenic shock have traditionally relied on extracorporeal membrane oxygenation. However, newer high-flow ventricular support devices such as the Impella 5.5 device, capable of providing effective circulatory support, ventricular unloading, and early mobilization with fewer device-related complications, have begun to challenge the systematic use of an extracorporeal membrane oxygenation-first approach. The clinical evolution of patients treated with the Impella 5.5 device and the impact of different support trajectories remain poorly characterized. We describe the clinical evolution of patients treated with the Impella 5.5 device according to initial support trajectory, distinguishing primary implantation from transition after venoarterial extracorporeal membrane oxygenation.Methods
This multicenter observational study included 114 consecutive patients with advanced heart failure or cardiogenic shock who underwent Impella 5.5 implantation in Spanish heart transplant centers. Patients were classified according to initial support trajectory: primary Impella 5.5 implantation (n = 72) or initial venoarterial extracorporeal membrane oxygenation support followed by transition to Impella 5.5 (venoarterial extracorporeal membrane oxygenation to Impella 5.5 transition, n = 42). Baseline characteristics, clinical trajectories, complications, and in-hospital outcomes were analyzed.Results
All patients ultimately received Impella 5.5 device support. In-hospital mortality was 27.8% in the primary Impella group and 69.0% in the extracorporeal membrane oxygenation-Impella group (P < .001), with an overall mortality of 43.0%. Heart transplantation as definitive therapy was achieved in 76.4% and 31.0% of patients, respectively (P < .001).Conclusions
In transplant-oriented centers, outcomes among patients supported with the Impella 5.5 device appear to differ according to support trajectory. Primary implantation was associated with lower mortality and greater access to heart transplantation than transition from extracorporeal membrane oxygenation to the Impella 5.5 device.
Related
- Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock
- National Use Patterns and Comparative Effectiveness of Extracorporeal Membrane Oxygenation in Myocardial Infarction–Related Cardiogenic Shock
- Single cell and bulk transcriptomics reveal metabolic reprogramming biomarker signatures during extracorporeal membrane oxygenation for cardiogenic shock
- Individualized Or Conventional Transfusion Strategy During Veno-Arterial Extracorporeal Membrane Oxygenation Support (ICONE Study): Rationale and Design of a Prospective Multicenter Randomized Controlled Trial
- Infectious Complications in Adults Receiving Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Nosocomial and Bloodstream Infection, Prevalence, Risk Factors, and Clinical Outcomes.
BibTeX
@article{martinezcomendador2026clinical,
title = {{Clinical outcomes of primary Impella 5.5 versus transition from extracorporeal membrane oxygenation in cardiogenic shock: A Spanish multicenter cohort.}},
author = {José Manuel Martínez-Comendador and Elio Martín Gutiérrez and Daniel Ortiz Berbel and Lucía García Alcalde and Álvaro Pedraz Prieto and Christian Muñoz Guijosa and Carlos Esteban Martín López and Stefano Urso and Gregorio Rábago Juan Aracil and Juan Bustamante-Munguira and José Joaquín Cuenca Castillo and Manuel Pérez Guillén},
journal = {JTCVS open},
year = {2026},
month = may,
doi = {10.1016/j.xjon.2026.101870},
url = {https://europepmc.org/article/MED/42948469},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical outcomes of primary Impella 5.5 versus transition from extracorporeal membrane oxygenation in cardiogenic shock: A Spanish multicenter cohort.
AU - José Manuel Martínez-Comendador
AU - Elio Martín Gutiérrez
AU - Daniel Ortiz Berbel
AU - Lucía García Alcalde
AU - Álvaro Pedraz Prieto
AU - Christian Muñoz Guijosa
AU - Carlos Esteban Martín López
AU - Stefano Urso
AU - Gregorio Rábago Juan Aracil
AU - Juan Bustamante-Munguira
AU - José Joaquín Cuenca Castillo
AU - Manuel Pérez Guillén
PY - 2026
DA - 2026/05/27
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101870
UR - https://europepmc.org/article/MED/42948469
AB - Objective Mechanical circulatory support strategies for cardiogenic shock have traditionally relied on extracorporeal membrane oxygenation. However, newer high-flow ventricular support devices such as the Impella 5.5 device, capable of providing effective circulatory support, ventricular unloading, and early mobilization with fewer device-related complications, have begun to challenge the systematic use of an extracorporeal membrane oxygenation-first approach. The clinical evolution of patients treated with the Impella 5.5 device and the impact of different support trajectories remain poorly characterized. We describe the clinical evolution of patients treated with the Impella 5.5 device according to initial support trajectory, distinguishing primary implantation from transition after venoarterial extracorporeal membrane oxygenation.Methods This multicenter observational study included 114 consecutive patients with advanced heart failure or cardiogenic shock who underwent Impella 5.5 implantation in Spanish heart transplant centers. Patients were classified according to initial support trajectory: primary Impella 5.5 implantation (n = 72) or initial venoarterial extracorporeal membrane oxygenation support followed by transition to Impella 5.5 (venoarterial extracorporeal membrane oxygenation to Impella 5.5 transition, n = 42). Baseline characteristics, clinical trajectories, complications, and in-hospital outcomes were analyzed.Results All patients ultimately received Impella 5.5 device support. In-hospital mortality was 27.8% in the primary Impella group and 69.0% in the extracorporeal membrane oxygenation-Impella group (P < .001), with an overall mortality of 43.0%. Heart transplantation as definitive therapy was achieved in 76.4% and 31.0% of patients, respectively (P < .001).Conclusions In transplant-oriented centers, outcomes among patients supported with the Impella 5.5 device appear to differ according to support trajectory. Primary implantation was associated with lower mortality and greater access to heart transplantation than transition from extracorporeal membrane oxygenation to the Impella 5.5 device.
SN - 2666-2736
ER -