Impella 5.5 as Bridge and Mechanical Support Following Simultaneous Heart/Kidney Transplant

In this case of a patient bridged to simultaneous heart-kidney transplant (SHKT) with an Impella 5.5, the device was preserved following heart transplant (HT) to provide mechanical support and facilitate kidney transplantation in the same operative encounter with the goal of reducing delayed kidney graft function. Our patient is a 60 year old man initially listed with status 5 for a combined heart/kidney transplant. Due to worsening hemodynamics and rising creatinine, a right axillary Impella 5.5 was inserted. The patient underwent a bicaval SHKT. During the aortic anastomosis, the Impella was repositioned across the aortic valve. The kidney was transplanted in the same encounter. The patient left the operating room (OR) on vasopressors, inotropes, and Impella support. There was immediate production of urine without needing renal replacement (RRT). The Impella was removed on postoperative day 4, and inotropes were discontinued by day 7. He produced more than 2.5 L of urine daily, with creatinine peaking at 2.39 mg/dl and ending at 0.9 mg/dl. He was discharged on postoperative day 15 and was seen as an outpatient with excellent graft function. Leaving the Impella for temporary support allowed for a kidney transplant in the same operative encounter, early mobilization, reduction of vasoactive agents, and may have reduced the risk of delayed graft function and need for RRT. 1) Scientific Image and Illustration Software. Central Image Heart Animation. BioRender. Accessed February 21, 2025. https://www.biorender.com/ . 2) Abiomed J&J MedTech. Central Image Impella 5.5 Animation. Accessed February 21, 2025. https://www.abiomed.com/en-us/patients-and-caregivers/about-impella .