(148) A Tale of 2 Pumps: Impella Versus IABP as a Bridge to Heart Transplant

Sunday, February 23, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 04

First Author(s)

Juhi Sahajwani, MBBS (she/her/hers)

Jacksonville, Florida, USA

Co-Author(s)

AS

Audrey Singletary, NA

NA
Mayo Clinic Florida, United States
Ashlesha Chaudhary, MBBS

Nepal
Allison Perez, MD

Mayo Clinic, USA
AK

Anil KC, MBBS

Research Collaborator
Mayo Clinic, United States
PP

Parag Patel, MD

Assistant Professor of Medicine
Mayo Clinic Florida, United States
Sanjay Chaudhary, MBBS (he/him/his)

Assistant Professor of Medicine
Mayo Clinic Florida
Jacksonville, Florida, United States

Introduction: Intra-aortic balloon pump (IABP) and Impella devices have been used as a bridge for patients awaiting heart transplant. We aimed to compare the outcomes in patients requiring Impella and IABP as a bridge to cardiac transplant.

Methods: This is a multi-center retrospective observational study that evaluated 366 patients undergoing heart transplants in Mayo Clinic between 2021-2023. A total of 146 patients required Impella or IABP as a bridge to cardiac transplant. Nine patients were excluded from the study who required both Impella and IABP. Data on outcomes such as mortality, length of ICU stay, length of hospital stay as well as demographics and cardiac function were collected and analyzed.

Results: The cohort consisted of 366 patients with 261 males (71%) with a mean age of 52.36 ± 14 years. A total of 146 patients required Impella and IABP, of which 90 patients were on Impella and 56 on IABP. The mean duration of support on Impella was 23± 20.1 days while on IABP was 14 ± 11.5 days (p=0.003).
The hospital length of stay and ICU length of stay (LOS) were significantly longer for patients using Impella (mean hospital stay = 51.49 51 ± 8 days, mean ICU stay= 29 ± 20.4 days) compared to IABP (mean hospital stay = 40 ± 5 days, mean ICU stay= 19± 16.02 days) (p < 0.05 for hospital LOS and p < 0.01 for ICU LOS).
Regarding cardiac function before transplantation, the mean ejection fraction was lower in the Impella group (20.22±11.37%) compared to the IABP group (28.03±17.78%) (p = 0.01). Dilated cardiomyopathy was the most common primary etiology for both groups (Impella 29.9% and IABP 18.36.
Mortality rates were higher in patients using Impella (5.6%) compared to IABP (7.1%), with the difference being statistically significant across different racial groups (p = 0.0135).

Conclusions: Our study indicates that patients supported with Impella as bridge to transplant had worse cardiac function at baseline but IABP patients had shorter length of hospital and ICU stay, mortality as well as a shorter duration of the mechanical circulatory support required.