276 Days of Support by a Micro-Axial Left Ventricular Assist Device as a Bridge to Heart Transplant.

The Impella 5.5 is a surgically implanted micro-axial left ventricular assist device (LVAD) increasingly utilized for mechanical circulatory support (MCS) in cardiogenic shock. While typically used for acute support up to FDA-approved 14 days, reports of prolonged utilization remain limited. We present the case of a 69-year-old male who presented with severe biventricular failure and cardiogenic shock who was bridged to heart transplantation (HT) utilizing a single Impella 5.5 for a total of 276 days. His prolonged support course was managed through a multidisciplinary approach addressing recurrent ventricular arrhythmias, renal failure, heparin-induced thrombocytopenia, and device management (suction alarms and purge flow limitations). Following successful HT, the explanted device demonstrated no mechanical injury or thrombus, and pathologic examination revealed no significant device-related structural heart damage. The patient was discharged without major complications and continued to do well at 5-month follow-up.