Comparison of Intraoperative Blood Product Use During Heart Transplantation in Patients Bridged with Impella 5.5 versus Durable Left Ventricular Assist Devices

Objective To determine if the intraoperative transfusion requirements differ based on the mechanical circulatory device used as a bridge to heart transplantation. Design A single-center retrospective analysis of intraoperative transfusion requirements in all patients undergoing heart or heart/kidney transplantation between November 2018 and July 2021 who were bridged with a temporary (Impella 5.5) or durable left ventricular assist device (LVAD). Setting A tertiary care hospital. Participants 43 adult patients bridged to heart or heart/kidney transplantation with a temporary or durable LVAD between 2018 and 2021 Interventions Recording of baseline characteristics and intraoperative transfusion requirements, including packed red blood cells (pRBCs), fresh frozen plasma (FFP), cryoprecipitate, autologous blood salvage, and platelets. The difference in cardiopulmonary bypass (CPB) times, intensive care unit length of stay (ICU), and the vasoactive inotrope score following transplantation were also recorded. Measurements and Main Results The primary outcome was the volume of blood products transfused intraoperatively. Patients who underwent bridge to transplantation using the Impella 5.5 had a statistically significant lower median transfusions of cryoprecipitate (155mL versus 200mL p=0.015), autologous blood salvage (675mL versus 1125mL p=<0.01), and platelets (412mL versus 675mL =<0.01). Additionally, there was a trend towards lower transfusion of intra-operative pRBC (4.5 units versus 6.5 units p=0.29) and FFP (675mL versus 800mL p=0.11), but these were not statistically significant. Conclusions The results suggest a reduction in certain intraoperative transfusion requirements in patients undergoing heart transplantation bridged with the Impella 5.5 versus durable left ventricular assist device.