SURGELLA: A Scoping Review of Impella-Assisted Hemodynamic Support in High-Risk Non-Cardiac Surgery.

BACKGROUND

Patients with advanced heart failure or severe ventricular dysfunction are often considered prohibitively high risk for non-cardiac surgery. Impella may provide temporary perioperative hemodynamic support by augmenting cardiac output and unloading the left ventricle, but evidence for this strategy remains limited and largely case based.

METHODS

We conducted a scoping review of Impella use for adult high-risk non-cardiac surgery. MEDLINE and Embase were searched from inception to April 2026, with supplementary hand-searching and citation tracking. Eligible reports were synthesized descriptively, with particular attention to implantation timing, operative context, device strategy, outcomes, and complications.

RESULTS

Twenty-three publications comprising 36 unique patients were identified. Evidence consisted mainly of case reports and small series. Impella was used across bariatric, abdominal, oncological, endocrine, transplant-related, vascular, orthopedic, and neurosurgical procedures. Clinical strategies included planned pre-emptive support, surgery during established Impella or ECMELLA support, rescue implantation after perioperative deterioration, and combined support strategies. Operative completion was usually reported and 34 of 36 unique published patients survived to hospital discharge; however, this reflects selected published experience rather than a reliable estimate of effectiveness or safety.

CONCLUSIONS

Impella-supported non-cardiac surgery appears technically feasible in highly selected patients treated in specialist centers. Current evidence supports feasibility, not comparative benefit or generalizable safety. Prospective multicenter data with standardized reporting are required before wider adoption can be justified.