The following article is from the Advanced Heart Failure referring provider newsletter.
Since 2018, a new heart allocation policy has meant that patients in certain areas of the country need to wait longer for a heart transplant. As a result, temporary left ventricular devices (LVADs) are becoming much more common as a bridge to transplant.
A team at UW Health Transplant Center, led by transplant cardiologist Peter Marogil, DO, recently found that patients who have used the temporary LVAD Impella 5.5 have a higher risk of having a stroke post-transplant if they have previously experienced a stroke.
Risk of blood clots
The Impella 5.5, which was approved by the Food and Drug Administration (FDA) in 2019, is a temporary heart pump that helps a weak heart pump blood more effectively to the rest of the body. It is placed in the heart via catheterization, and once it’s in position, a microaxial motor in the device spins to create a pumping action.
This particular LVAD is used while a patient is in the hospital awaiting a heart transplant. It has become very popular in recent years because it is designed for a longer duration of support. That, however, could lead to problems, said Dr. Marogil.
Stroke is a risk factor
For the study, researchers queried the United Network for Organ Sharing (UNOS) to find patients who were bridged to cardiac transplant with the Impella 5.5 between January 2021 and June 2024. Then, they examined the data to determine how many patients experienced a stroke.
Out of 586 patients who used the Impella 5.5 during the study period, 32, or 5.5%, had a post-transplant stroke.
Of these patients, a pretransplant stroke was a significant risk factor—a finding that was not surprising, Dr. Marogil said, given that history of stroke is a risk factor for stroke in the general population, too.
He noted that patients who require an Impella 5.5 are critically ill and in cardiogenic shock.
“We need to support them,” he said. “But this data tells me that we should tailor the choice of device to the individual patient. There are other methods of treating patients with this degree of advanced heart failure, such as an intra-aortic balloon pump.”
“We as clinicians need to individually tailor our strategy of managing these patients while they’re waiting for a heart transplant,” Dr. Marogil concluded.
Marogil, et al. Post-Transplant Stroke in Patients Bridged to Transplantation With Impella 5.5 in the Era of Prolonged Duration of Support. American Society for Artificial Internal Organs Journal.