Midterm outcomes of patients with native heart recovery after Impella 5+ for cardiogenic shock

Left ventricular unloading by percutaneous microaxial flow-pump devices has been shown to improve survival in patients with cardiogenic shock (CS). The objective of the study is to examine whether Impella 5.0/5.5 (5+) support is effective in facilitating heart recovery, overall survival, and quality of life. This single-centre retrospective study examined midterm (180 days) outcomes of patients with CS supported by Impella 5+ who achieved heart recovery. The primary endpoint was survival at 180 days and freedom from implantable cardioverter-defibrillator (ICD), heart transplant/left ventricular assist device (LVAD), or readmission for heart failure. Functional status was assessed with New York Heart Association (NYHA) classification. Between June 2022 and April 2024, 20 patients with CS (64 ± 8.9 years, 80% male) received Impella 5+ and discharged with heart recovery. Before Impella placement, mean left ventricular ejection fraction (LVEF) was 19.2 ± 5.2%, 7 (35%) patients were SCAI stage C, 9 (45%) SCAI stage D, and 4 (20%) SCAI stage E, and the mean vasoactive-inotropic score was 23.2 ± 38.0. The average duration of Impella support was 10.5 ± 8 days. At 180 days, 19 (95%) patients were alive, no patient received a heart transplant/LVAD, 40% were implanted with an ICD and there were two admissions for heart failure. The mean LVEF was 33.5 ± 10.7%, 5 (26.3%) patients were NYHA class I, 9 (47.4%) were NYHA class II, and 5 (26.3%) were NYHA class III. One patient died from a non-cardiac cause. Impella 5+ represents a promising treatment strategy for CS, providing high rates of sustained native heart recovery. A comprehensive platform of mechanical and pharmacological unloading is key.