Impella 5.5 Support Prior to Heart and Kidney Transplantation.

Impella 5.5 Support Prior to Heart and Kidney Transplantation.

Alpuerto, A.C.

Lele, P.

Mahr, C.

Bakthavatsalam, R.

Khorsandi, M.

Keenan, J.E.

2022

End-stage renal disease (ESRD) is a challenge when evaluating patients for advanced heart failure therapies. We present a patient with end-stage heart failure (HF) and ESRD, who was successfully bridged to heart and kidney transplantation using Impella 5.5 (Abiomed, Danvers, MA, USA) following bilateral nephrectomy. A 37-year-old, obese man with nonischemic cardiomyopathy from remote methamphetamine use presented with symptoms of decompensated HF despite being on a Milrinone infusion. Concomitantly, he had ESRD secondary to xanthogranulomatous pyelonephritis in a setting of chronic staghorn calculi (Figure 1). Given his progression to refractory HF, he was considered for dual organ transplantation. As a prerequisite to kidney transplantation, bilateral nephrectomy was performed for source control of the chronic pyelonephritis. Post-operative course was complicated by hemodynamic deterioration with early end-organ dysfunction despite an intra-aortic balloon pump support. He was brought to the operating room to emergently escalate his support to an Impella 5.5. Upon induction, he went into cardiac arrest. After the return of spontaneous circulation, an Impella 5.5 was placed. The device reached blood flows up to 5.2 liters per minute, which preserved him during his surgical recovery while undergoing continuous renal replacement therapy. There were no complications of malpositioning, thrombosis, or hemolysis. 30 days later, he had a combined heart and kidney transplantation. He continues to have excellent graft function after 5 months. To our knowledge, this is the first reported successful use of Impella 5.5 to preserve a patient prior to a heart and kidney transplantation following bilateral nephrectomy. This case highlights how Impella 5.5 can be an invaluable tool to provide left ventricular support and as a bridge to heart transplantation for patients with end-stage HF who have kidney disease and/or recovering from major abdominal operations.

Journal of Heart & Lung Transplantation. 2022Supplement, Vol. 41 Issue 4, pS494-S494. 1p.

English