Anek Jena, Aayushi Pareek, Said Bateh, Saleem Faiz, Gustavo Olaizola, Ivan Huespe, Susana Bauque, Eduardo Prado, Abby Hanson, Saurabh Sujanyal, John Haney, Penny Amoroso, Sara Vilela, KIMBERLY BRITTON, Nikki Matos, Michelle Ojard, Sean Kiley, Rachel Hannon, Juan Carlos Leoni Moreno, Mathew Thomas, Başar Sareyyüpoğlu, Lydia Sura, Greg Worsowicz, M. Lyle, Parag Patel, Pablo Moreno Franco, Devang Sanghavi, Anna Shapiro
Prehabilitation with Impella 5.5 offers hemodynamic support while allowing early mobilization, yet its overall effect on post-transplant recovery remains unclear. The aim was to assess recovery during Impella 5.5-supported prehabilitation and determine its association with early post-heart transplant outcomes, including a potential dose-response relationship with ambulatory activity. We conducted a single-center retrospective cohort study of adults bridged to transplant with Impella 5.5 between April 1, 2022 and September 30, 2024. Daily walking distance, recorded by nursing staff, served as the intervention. Primary outcome was postoperative hospital length of stay (LOS); the secondary outcome was time to extubation. Fine-Gray competing-risk models, adjusted for age, Sequential Organ Failure Assessment (SOFA) score, New York Heart Association (NYHA) class, and days of Impella support, assessed associations. Longitudinal recovery trajectories were analyzed with linear mixed-effects models incorporating restricted cubic splines. Among 82 eligible patients, 65 met the inclusion criteria. Patients who walked farther during Impella 5.5 support in the intensive care unit (ICU) had shorter hospital stays and were taken off the ventilator sooner after transplantation. The overall recovery peaked during the first 2-3 weeks of support, with smaller recovery thereafter, indicating that most functional recovery occurred early during prehabilitation.