(784) Impella 5.5 Use as a Bridge to Transplant in Hereditary Transthyretin Amyloidosis

IntroductionLittle is known about the use of the newer generation's temporary mechanical circulatory (tMCS) device, the Impella 5.5, in patients with restrictive cardiomyopathies.Case Report55-year old African-American male with non-ischemic cardiomyopathy secondary to hereditary transthyretin amyloidosis and listed for heart transplantation, presented for a right heart catheterization that showed increased biventricular filling pressures with a cardiac index (CI) of 0.93 L/min/m2 despite home milrinone use. Even after attempts to optimize hemodynamics with dual inotropes, the patient continued to decline. While there were concerns with his restrictive physiology, relatively small left ventricular cavity size of 4.9 cm, and concentric hypertrophy, the team placed an axillary Impella 5.5 for further hemodynamic support (Image 1). At P7 support, the patient's hemodynamics improved to a CI of 2.9 L/min/m2, reducing his inotropic needs. The patient tolerated the Impella 5.5 until a suitable donor heart became available 3 days later. Despite the proximity of the Impella inflow cannula to the hypertrophied septum, the patient did not have any device related alarms or complications. Additionally, he also had no tMCS related complications peri and post-transplant.SummaryThe Impella 5.5 can safely support patients with restrictive physiology and small ventricular cavities as a bridge to transplantation. Little is known about the use of the newer generation's temporary mechanical circulatory (tMCS) device, the Impella 5.5, in patients with restrictive cardiomyopathies. 55-year old African-American male with non-ischemic cardiomyopathy secondary to hereditary transthyretin amyloidosis and listed for heart transplantation, presented for a right heart catheterization that showed increased biventricular filling pressures with a cardiac index (CI) of 0.93 L/min/m2 despite home milrinone use. Even after attempts to optimize hemodynamics with dual inotropes, the patient continued to decline. While there were concerns with his restrictive physiology, relatively small left ventricular cavity size of 4.9 cm, and concentric hypertrophy, the team placed an axillary Impella 5.5 for further hemodynamic support (Image 1). At P7 support, the patient's hemodynamics improved to a CI of 2.9 L/min/m2, reducing his inotropic needs. The patient tolerated the Impella 5.5 until a suitable donor heart became available 3 days later. Despite the proximity of the Impella inflow cannula to the hypertrophied septum, the patient did not have any device related alarms or complications. Additionally, he also had no tMCS related complications peri and post-transplant. The Impella 5.5 can safely support patients with restrictive physiology and small ventricular cavities as a bridge to transplantation.