Patel, Parag J.

Background: Renal dysfunction is a known prognostic factor in advanced heart failure and among patients receiving temporary mechanical circulatory support (tMCS). However, the predictive value of post-Impella creatinine in determining healthcare resource utilization in patients bridged to transplant with Impella 5.5 remains unclear. This study aimed to evaluate the association between post-Impella creatinine and key hospitalization metrics in this population. Methods: We performed a retrospective cohort study of patients who received Impella 5.5 as a bridge-to-transplant between January 2020 and January 2025. Serum creatinine was collected 72 hours after Impella placement. The primary outcome was device-to-discharge time. Secondary outcomes included transplant-to-discharge time, post-transplant ICU length of stay (LOS), and total LOS (admission-discharge). Univariate and multivariable linear regressions were used to examine the association between post-Impella creatinine and each outcome, adjusting for age, gender, BMI, and LVEF. Results: 133 patients were supported with the Impella 5.5 as BTT and were included (median age 58 years (51–65), 82.7% were male, and 71.4% presented with non-ischemic cardiomyopathy. The median BMI was 27.7 (24.3–32.3), LVEF 17% (15–22), and post-Impella creatinine 1.32 mg/dL (0.96–1.71). The median device-to-discharge time was 45 days (29-64), transplant-to-discharge time was 14 days (12–19), ICU LOS post-transplant was 6 days (4–8), and total LOS was 58 days (42–76). Higher post-Impella creatinine was significantly associated with longer device-to-discharge time (β = 6.67, p = 0.004), longer transplant-to-discharge duration (β = 3.42 p = 0.003), longer ICU LOS (β = 2.19, p = 0.007), and longer total LOS (β = 7.24, p = 0.002) on univariate analysis. Post-impella creatinine remained significantly associated with device-to-discharge time in the multivariate model after adjusting for confounders (β = 6.33, p = 0.006). Importantly, this suggests that patients with lower post-Impella creatinine levels may experience shorter hospitalizations and faster recovery trajectories following transplant. Conclusions: Post-Impella creatinine is a significant predictor of prolonged hospitalization in patients supported with Impella 5.5 as a bridge to transplant. These findings emphasize the prognostic importance of early renal function assessment and may guide risk stratification and resource planning in advanced heart failure care.

Abstract Rationale: Early management after heart transplantation is essential for survival and quality of life, but we lack data on how initial clinical measures might predict patient outcomes. This study investigates whether early postoperative hemodynamic and clinical parameters can predict 1-year mortality and complications. Methods: We conducted a retrospective study of 550 heart transplant patients treated at the Mayo Clinic from 2019 to 2023. Demographic, hemodynamic, and clinical data, including Central Venous Pressure (CVP), Pulmonary Arterial Pressure (PAP), cardiac index, Pulmonary Artery Pulsatility Index (PaPi), blood pressure, heart rate, and Vasoactive-Inotropic Score (VIS), were collected. Key outcomes included 1-year mortality, Intensive Care Unit (ICU) and hospital stay durations, and complications such as respiratory issues and Acute Kidney Injury (AKI). Patients were divided into quartiles based on VIS scores to compare clinical outcomes. Logistic regression assessed how each parameter predicted 1-year mortality. Results: The patients’ mean age was 53.3±13.1 years, with 391 (71.1%) male and an average Body Mass Index (BMI) of 27.5±4.9. The median ICU stay was 9 days (Interquartile Range [IQR]: 4-22.8), and the median hospital stay was 35 days (IQR: 17-57.8). Within one year, 28 (5.1%) patients experienced mortality and ICU readmission occurred in 52 (9.5%) patients. Higher VIS quartiles were associated with worse outcomes. Logistic regression revealed three significant predictors of 1-year mortality: higher CVP (p=0.0305) and lower Systolic Blood Pressure (SBP) (p=0.0484) were linked to increased mortality risk, while each unit increase in VIS (p=0.0355) raised mortality odds by 6% (Odds Ratio [OR]: 1.06, 95% Confidence Interval [CI]: 1.004-1.113). Additionally, respiratory complications were seen in 177 (32.2%) patients, and AKI in 407 (74.0%) patients. AKI significantly predicted mortality (OR=2.50, p=0.044), while both ICU readmission (OR=2.98, p<0.001) and AKI (OR=3.49, p<0.001) predicted respiratory complications. Conclusions: Early postoperative hemodynamic and clinical parameters, especially higher VIS scores, are significant indicators of 1-year mortality in heart transplant patients. These findings highlight the importance of early assessment to identify high-risk patients and potentially guide post-transplant management strategies.