Impella 5.5 Support Prior to Heart and Kidney Transplantation

IntroductionEnd-stage renal disease (ESRD) is a challenge when evaluating patients for advanced heart failure therapies. We present patient with end-stage (HF) and ESRD, who was successfully bridged to kidney transplantation using Impella 5.5 (Abiomed, Danvers, MA, USA) following bilateral nephrectomy.Case ReportA 37-year-old, obese man nonischemic cardiomyopathy from remote methamphetamine use presented symptoms of decompensated HF despite being on Milrinone infusion. Concomitantly, he had ESRD secondary xanthogranulomatous pyelonephritis in setting chronic staghorn calculi (Figure 1). Given his progression refractory HF, considered dual organ transplantation. As prerequisite transplantation, nephrectomy performed source control the pyelonephritis. Post-operative course complicated by hemodynamic deterioration early end-organ dysfunction an intra-aortic balloon pump support. He brought operating room emergently escalate support 5.5. Upon induction, went into cardiac arrest. After return spontaneous circulation, placed. The device reached blood flows up 5.2 liters per minute, which preserved him during surgical recovery while undergoing continuous replacement therapy. There were no complications malpositioning, thrombosis, or hemolysis. 30 days later, combined continues have excellent graft function after 5 months.SummaryTo our knowledge, this first reported successful preserve prior nephrectomy. This case highlights how can be invaluable tool provide left ventricular as bridge and/or recovering major abdominal operations. End-stage A months. To