Long-Term Outcomes of Native Heart Survival in Cardiogenic Shock Patients Treated With Impella 5.5.

Native heart survival following Impella 5.5 support for cardiogenic shock is a desirable outcome that remains poorly characterized, especially amid evolving transplant policies and growing use of temporary mechanical circulatory support. We conducted a single-center retrospective analysis of adults treated with Impella 5.5 for refractory cardiogenic shock between December 2020 and December 2024 to evaluate long-term outcomes among those who survived to discharge without durable support or transplant. Of 198 patients treated, 68 (31.3%) achieved native heart survival. Survival was 92.6% at 30 days, 91.2% at 90 days, and 76.5% at 1 year. Common etiologies were acute myocardial infarction (45.6%) and acute decompensated heart failure (33.8%), with no significant difference in 1 year survival between groups (77.4% vs. 82.6%, p = 0.74). Outcomes and complications were similar across subgroups. These findings highlight that native heart survival is achievable for a meaningful proportion of patients treated with Impella 5.5. In the context of shortened transplant waitlist times following the 2018 United Network for Organ Sharing (UNOS) allocation changes, structured weaning and medical optimization may enhance opportunities for recovery and reduce reliance on long-term support or transplantation.