The Increasing Utilization of the Impella Device as a Bridge-to-Transplantation in Pediatric Heart Centers Across the United States

Abstract

Objective

Reports on the use of the Impella device in children undergoing heart transplantation have been limited. We sought to provide what is to our knowledge the first multi-institutional national report of pediatric Impella device utilization as a bridge-to-heart transplant strategy.

Methods

All patients (<18 years) who underwent Impella placement in the United Network for Organ Sharing (UNOS) from the first use in 2013 to June 2024 were identified. Descriptive analysis was performed, and posttransplant survival analyzed using Kaplan-Meier survival analysis.

Results

Fifty children who underwent Impella placement were identified. All UNOS regions utilized the Impella device in pediatric patients. The earliest use was in 2013. Starting in 2022, use as a bridge-to-transplantation experienced a more than two-fold increase, with a consistent rise to 11 devices in 2023 and 10 devices as of June 2024. The median age at Impella implantation was 15 years [13-17]. The median weight was 61 kg [48-82], and the median height was 167 cm [153-172]. The most frequent listing diagnosis was cardiomyopathy (N = 35/50, 70%), followed by congenital heart disease (N = 10/50, 20%). The median device duration was 12 days [6-21], and among all 50 children, 84% (N = 42) underwent heart transplantation the one-year survival was 94.45% [91.23%-97.59%].

Conclusion

This report demonstrates the diverse and increasing use of the Impella device as a bridge-to-heart transplantation strategy in children. While early outcomes are promising, investigation is warranted to understand how this less invasive and versatile device can maximize outcomes for children.