Planned Impella 5.5 Support via Brachiocephalic Artery or Ascending Aorta for Low Ejection Fraction, High-Risk Cardiac Surgery

Background: Surgically implanted microaxial flow pumps are increasingly being utilized to treat cardiogenic shock; however, data on their use in the realm of cardiac surgery are scarce. We report our single-institution experience in low-ejection-fraction, high-risk patients with a planned weaning strategy from cardiopulmonary bypass directly to Impella 5.5 inserted via the brachiocephalic artery or ascending aorta following corrective cardiac surgery. Methods: A prospectively maintained institutional database was queried from 2022 through to 2025. Primary endpoints included feasibility of implantation, weaning rate, and bedside removal; secondary endpoints included freedom from all-cause mortality at discharge and 1 year, in-hospital thromboembolic complications, postoperative pharmacologic hemodynamic support using vasoactive inotropic score (VIS), de novo renal failure, and revision for bleeding. Descriptive statistics were applied. Results: Sixteen patients (median age 66.5 years [IQR; interquartile range, 52.5–70.0], STS score 12.1% [IQR, 5.3–14.2%] and EF 20.0% [IQR, 15.0–31.5%]) underwent coronary revascularization (n = 6), valve procedures (n = 4) or a combination thereof (n = 6) and were weaned from cardiopulmonary bypass to Impella 5.5 implanted via the ascending aorta (25%) or brachiocephalic artery (75%). Primary endpoints were met in 100% (feasibility of implantation), 94% (weaning rate), and 100% (bedside removal). In terms of secondary endpoints, freedom from mortality at discharge and one year was 94.8%; there were two non-disabling strokes (12.6%) while still on Impella 5.5 support; the median VIS at the time of ICU arrival was 12.8 (IQR 10.8–22.1); renal failure occurred in two patients and four patients required revision for bleeding. Conclusions: Impella 5.5-supported cardiac surgery appears safe and may open a new avenue for high-risk patients.