High capacity Impella, an effective mechanical support strategy for patients in cardiogenic shock bridged to heart transplantation

To the Editor, Heart transplantation remains the gold standard treatment for patients with advanced heart failure. However, over the past decade, waiting times for elective transplantation have increased, reaching a mean of 186 days, leading to clinical deterioration in these patients while awaiting an organ.1 Consequently, the use of temporary mechanical support devices has become a necessity. Although several options remain available, such as intra-aortic balloon pump, TandemHeart (CardiacAssist, United States), or extracorporeal membrane oxygenation (ECMO), the use of temporary percutaneous devices is on the rise.2 One of these temporary percutaneous devices, the Impella CP, has already been successfully utilized for this purpose.3,4 Although there are several versions of the Impella device (2.5, CP, 5.0) each with its own limitations, the recently introduced 5.5 offers advantages, such as high flow, an average support duration of 1 month, and axillary implantation. The emergence of the new high-flow axillary Impella devices—5.0 and 5.5—with a CE-marked duration of up to 1 month and their equivalence to surgical assist devices requiring sternotomy, such as Levitronix (Switzerland), in terms of emergency criteria for organ allocation, minimizing associated morbidity, has changed the landscape of emergency heart transplantation.5 Several experiences using the Impella 5.5 strategy for temporary mechanical support...