Pub Date : 2025-11-01Epub Date: 2025-06-24DOI: 10.1016/j.healun.2025.06.008
Alexander M Bernhardt, Vanessa Blumer, Christophe Vandenbriele, Benedikt Schrage, Kanika Mody, Federico Pappalardo, Scott Silvestry, Mark Anderson, Jacob Abraham, Ann Gage, Daniel Goldstein, Michael Grant, Ilija Klipa, Thomas Schlöglhofer, Sern Lim, Jacob Moller, Bernd Panholzer, Ezequiel Molina, Julia Riebandt, Nir Uriel, Anthony Carnicelli, Evgenij Potapov, Manreet Kanwar
The Impella 5.5 (Abiomed, USA) is a catheter-based micro-axial flow pump that has emerged as a vital tool in managing patients with cardiogenic shock (CS). Delivering up to 5.5 L/min of flow, it enables full left ventricular (LV) support with beneficial hemodynamic and metabolic effects. Its unique advantages include high-flow, antegrade circulatory support with the potential for prolonged usage, making it suitable for bridging to recovery or heart replacement therapies. This manuscript provides a comprehensive, structured guide for the clinical management of patients supported with the Impella 5.5. It outlines best practices for patient selection, surgical implantation techniques-most commonly via the axillary artery-perioperative management, anticoagulation strategies, and postoperative monitoring. Special emphasis is placed on complication management, including bleeding, hemolysis, right ventricular dysfunction, stroke, aortic valve injury, and vascular complications. Technologies like SmartAssist and Impella Connect are highlighted for their utility in real-time device monitoring and remote management. The manuscript also discusses a three-phase framework for recovery: hemodynamic stabilization, initiation of guideline-directed medical therapy (GDMT), and structured weaning protocols. Considerations for transitioning patients to heart transplantation or durable LVADs, as well as explant techniques, are detailed. The importance of multidisciplinary coordination-including a mechanical circulatory support (MCS) coordinator-is emphasized to ensure optimal patient outcomes. By synthesizing available evidence and institutional experience, this guide aims to standardize Impella 5.5 management, reduce complications, and improve outcomes in critically ill patients with advanced heart failure or CS.
{"title":"Clinical management of the Impella 5.5 pump.","authors":"Alexander M Bernhardt, Vanessa Blumer, Christophe Vandenbriele, Benedikt Schrage, Kanika Mody, Federico Pappalardo, Scott Silvestry, Mark Anderson, Jacob Abraham, Ann Gage, Daniel Goldstein, Michael Grant, Ilija Klipa, Thomas Schlöglhofer, Sern Lim, Jacob Moller, Bernd Panholzer, Ezequiel Molina, Julia Riebandt, Nir Uriel, Anthony Carnicelli, Evgenij Potapov, Manreet Kanwar","doi":"10.1016/j.healun.2025.06.008","DOIUrl":"10.1016/j.healun.2025.06.008","url":null,"abstract":"<p><p>The Impella 5.5 (Abiomed, USA) is a catheter-based micro-axial flow pump that has emerged as a vital tool in managing patients with cardiogenic shock (CS). Delivering up to 5.5 L/min of flow, it enables full left ventricular (LV) support with beneficial hemodynamic and metabolic effects. Its unique advantages include high-flow, antegrade circulatory support with the potential for prolonged usage, making it suitable for bridging to recovery or heart replacement therapies. This manuscript provides a comprehensive, structured guide for the clinical management of patients supported with the Impella 5.5. It outlines best practices for patient selection, surgical implantation techniques-most commonly via the axillary artery-perioperative management, anticoagulation strategies, and postoperative monitoring. Special emphasis is placed on complication management, including bleeding, hemolysis, right ventricular dysfunction, stroke, aortic valve injury, and vascular complications. Technologies like SmartAssist and Impella Connect are highlighted for their utility in real-time device monitoring and remote management. The manuscript also discusses a three-phase framework for recovery: hemodynamic stabilization, initiation of guideline-directed medical therapy (GDMT), and structured weaning protocols. Considerations for transitioning patients to heart transplantation or durable LVADs, as well as explant techniques, are detailed. The importance of multidisciplinary coordination-including a mechanical circulatory support (MCS) coordinator-is emphasized to ensure optimal patient outcomes. By synthesizing available evidence and institutional experience, this guide aims to standardize Impella 5.5 management, reduce complications, and improve outcomes in critically ill patients with advanced heart failure or CS.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":" ","pages":"1688-1702"},"PeriodicalIF":6.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.016
Carlos E. Zari-Hidalgo MD
{"title":"Clarification on Ischemia–Reperfusion Injury Pathophysiology","authors":"Carlos E. Zari-Hidalgo MD","doi":"10.1016/j.healun.2025.06.016","DOIUrl":"10.1016/j.healun.2025.06.016","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Page 1848"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.031
Abby McCaig , Mingyao Liu MD
{"title":"Endothelial glycocalyx and human ex vivo lung perfusion: Potential biomarkers and therapeutic targets for lung transplantation","authors":"Abby McCaig , Mingyao Liu MD","doi":"10.1016/j.healun.2025.06.031","DOIUrl":"10.1016/j.healun.2025.06.031","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Pages 1843-1844"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.015
B.C.J. van Dijk , D. Bos , R.A. de Boer , R.P.J. Budde , O.C. Manintveld
{"title":"Letter to the Editor: Can the grading of mild cardiac allograft vasculopathy be further refined? An angiographic and physiologic assessment of heart transplant recipients with ISHLT CAV 1","authors":"B.C.J. van Dijk , D. Bos , R.A. de Boer , R.P.J. Budde , O.C. Manintveld","doi":"10.1016/j.healun.2025.06.015","DOIUrl":"10.1016/j.healun.2025.06.015","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Pages 1845-1846"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.024
Nikil Prasad MD , Kevin J. Clerkin MD, MSc
{"title":"Author Response: Can the grading of mild cardiac allograft vasculopathy be further refined? An angiographic and physiologic assessment of heart transplant recipients with ISHLT CAV 1","authors":"Nikil Prasad MD , Kevin J. Clerkin MD, MSc","doi":"10.1016/j.healun.2025.06.024","DOIUrl":"10.1016/j.healun.2025.06.024","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Page 1847"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.07.008
Yasbanoo Moayedi MD , Amit Alam MD , Manreet Kanwar MD
{"title":"Response letter to the editor","authors":"Yasbanoo Moayedi MD , Amit Alam MD , Manreet Kanwar MD","doi":"10.1016/j.healun.2025.07.008","DOIUrl":"10.1016/j.healun.2025.07.008","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Page 1849"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/S1053-2498(25)02299-5
{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(25)02299-5","DOIUrl":"10.1016/S1053-2498(25)02299-5","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Page A2"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.033
Magali J. Fontaine
{"title":"Evaluating perfusate composition in ex vivo normothermic heart perfusion: Red blood cells or plasma?","authors":"Magali J. Fontaine","doi":"10.1016/j.healun.2025.06.033","DOIUrl":"10.1016/j.healun.2025.06.033","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Pages 1821-1822"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.06.006
Kentaro Noda PhD , Pablo G. Sanchez MD, PhD, FACS
{"title":"Glycocalyx and endothelial injury as predictors of lung graft function and therapeutic targets in EVLP and lung transplantation","authors":"Kentaro Noda PhD , Pablo G. Sanchez MD, PhD, FACS","doi":"10.1016/j.healun.2025.06.006","DOIUrl":"10.1016/j.healun.2025.06.006","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Pages 1841-1842"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.healun.2025.05.021
Sandeep Sahay , Scott Visovatti , Adriano R. Tonelli , Nelson Villasmil Hernandez , Eric D. Austin , Roberto Badagliacca , Rolf M.F. Berger , Athénaïs Boucly , Yucheng Chen , Colin Church , Marion Delcroix , Allen D. Everett , Harrison W. Farber , Charles Fauvel , Mardi Gomberg-Maitland , Megan Griffiths , Francois Haddad , Yuchi Han , Anna Hemnes , Marius M. Hoeper , Raymond L. Benza
{"title":"Authors’ Perspective on the International Society for Heart and Lung Transplantation Consensus Statement on Risk Stratification in Pulmonary Arterial Hypertension","authors":"Sandeep Sahay , Scott Visovatti , Adriano R. Tonelli , Nelson Villasmil Hernandez , Eric D. Austin , Roberto Badagliacca , Rolf M.F. Berger , Athénaïs Boucly , Yucheng Chen , Colin Church , Marion Delcroix , Allen D. Everett , Harrison W. Farber , Charles Fauvel , Mardi Gomberg-Maitland , Megan Griffiths , Francois Haddad , Yuchi Han , Anna Hemnes , Marius M. Hoeper , Raymond L. Benza","doi":"10.1016/j.healun.2025.05.021","DOIUrl":"10.1016/j.healun.2025.05.021","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"44 11","pages":"Pages 1683-1687"},"PeriodicalIF":6.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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