Repeat Impella 5.5 During Single Hospitalization: A Single Center Experience.

INTRODUCTION: The Impella 5.5 device is a temporary mechanical circulatory support device widely used in patients with refractory cardiogenic shock. However, device-related or device-associated complications, as well as recurrent cardiogenic shock after device removal, may necessitate repeat implantation during the same hospitalization. METHODS: Out of 579 who underwent Impella 5.5 implantation at our institution between January 2020 and 2026, we reviewed the 14 patients who required repeated insertion during a single hospitalization. Indications for repeat implantation were categorized as device-related failure or physiologic deterioration. The primary outcome was survival to hospital discharge. Secondary outcomes included stroke, surgical-site infection, and access-site bleeding. RESULTS: Patients had a median age of 57 years, and 79% were male. Indications for repeat implantation were device-related failure in 57% (8/14) and physiologic deterioration in 43% (6/14). Median interval between devices was 10.5 days (IQR, 6-22). Repeat implantation was performed through the same axillary access site in 57% (8/14) and a new access site in 43% (6/14). After initial device insertion, 50% required VA-ECMO and 28%. Survival to hospital discharge was 71% (10/14); however, post-reimplantation complications were frequent, with stroke and access-site bleeding each occurring in 29% of patients and surgical-site infection in 7%. Five patients (36%) underwent durable LVAD implantation and 5 (36%) underwent heart or heart-kidney transplantation. CONCLUSIONS: Repeat Impella 5.5 implantation during a single hospitalization was uncommon and was performed in a highly selected cohort with favorable survival outcomes, although accompanied by a substantial rate of neurological and local bleeding complications. These descriptive findings should be interpreted in the context of substantial selection bias, small sample size, and single-center experience.