Lyle, M.

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.

Abstract Background: Amyloidosis is a complex disease with a multitude of sequalae, particularly with the variants that cause cardiac amyloidosis. There is minimal literature on the types of procedures these patients undergo and the associated postprocedural outcomes. This gap of knowledge makes it difficult for anesthesia providers to risk stratify amyloidosis patients. Methods: This is a single-center, retrospective chart review study performed at a tertiary care medical center that serves as a referral center for patients with amyloidosis. Patients with a known diagnosis of transthyretin (ATTR) or light chain (AL) amyloidosis who underwent procedures requiring anesthesia between January 1, 2018 and October 24, 2024 were included in the study. The primary outcome was 30-day all-cause mortality. Secondary outcomes included other postoperative complications and analysis of types of procedures requiring anesthesia. Results: During the study period, 160 patients underwent a total of 466 procedures requiring anesthesia. Overall, 30-day mortality rate for all encounters was 1.7% (2.7% AL vs 0.5% ATTR, OR 5.71). Endoscopy was the most common procedure, accounting for 26.6% of all procedures. At the patient level, several procedures were more common in ATTR patients including TEE/Cardioversions (21.7% vs 6.6%, p=0.008), electrophysiology (36.2% vs 9.9%, p<0.001), and neurosurgery (13.0% vs 3.3%, p=0.031). Conclusions: In conclusion, patients with amyloid variants that cause cardiac amyloidosis carry substantial postoperative risk when undergoing procedures, with a trend toward increased mortality in patients with AL compared to ATTR. Patients with ATTR are more likely to require neurosurgery and treatment of arrythmias than patients with AL. Additional studies are needed to determine specific diagnostic parameters to help optimize these patients in the future. Trial Registration : Not applicable. Not a clinical trial