{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:52:38Z","timestamp":1787669558516,"version":"build-2736575974"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Hemolysis, variably defined in mechanical circulatory support (MCS), is understudied in percutaneous left ventricular assist devices. We characterize hemolytic sequelae of Impella 5.5-supported patients in the largest series to date.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>All Impella 5.5 patients at our center from 2020 to 2023 were identified (<jats:italic>n<\/jats:italic>\u2009=\u2009169) and retrospectively reviewed. Patients with a plasma free hemoglobin (PfHb) recorded (and not previously elevated) were included (<jats:italic>n<\/jats:italic>\u2009=\u2009123). The top (high hemolysis [HH], <jats:italic>n<\/jats:italic>\u2009=\u200926) and bottom (low hemolysis [LH], <jats:italic>n<\/jats:italic>\u2009=\u200925) quintiles were categorized based on PfHb levels. Analysis between groups identified factors associated with hemolysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>HH patients had higher admission SCAI stages (<jats:italic>p<\/jats:italic>\u2009=\u20090.008), more Impella 5.5 days (23.5 v 10.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), more additional MCS (16\/26 [61.5%] v 6\/25 [24.0%], <jats:italic>p<\/jats:italic>\u2009=\u20090.015), and more transfusions of packed red blood cells (12.5 v 4.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), fresh frozen plasma (2.5 v 0.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.033), and platelets (3.0 v 0.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Logistic regression identified additional MCS (OR 10.82, <jats:italic>p<\/jats:italic>\u2009=\u20090.004) and more Impella days (OR 1.13 <jats:italic>p<\/jats:italic>\u2009=\u20090.006) as hemolysis risk factors. Eleven (44%) LH and 19\/26 (73%) HH patients died, with no significant differences between postoperative complications. Compared with those who died, HH survivors had fewer platelet transfusions (2.0 vs. 5.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and less PfHb elevation days (3.0 v 6.0, <jats:italic>p<\/jats:italic>\u2009=\u20090.007).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Hemolysis in this high-risk cohort has a poor prognosis. HH patients spent more days on Impella 5.5, needed more MCS, and required more blood product transfusions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13019-025-03352-7","type":"journal-article","created":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T01:49:41Z","timestamp":1740793781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of hemolysis in patients supported with Impella 5.5: a single center experience"],"prefix":"10.1186","volume":"20","author":[{"given":"Jessica S.","family":"Clothier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge","family":"Kobsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynette","family":"Lester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithya","family":"Rajeev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markian","family":"Bojko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Praeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Barr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"issue":"7","key":"3352_CR1","doi-asserted-by":"publisher","first-page":"334","DOI":"10.4330\/wjc.v12.i7.334","volume":"26","author":"CA Papanastasiou","year":"2020","unstructured":"Papanastasiou CA, Kyriakoulis KG, Theochari CA, Kokkinidis DG, Karamitsos TD, Palaiodimos L. Comprehensive review of hemolysis in ventricular assist devices. World J Cardiol. 2020;26(7):334\u201341. https:\/\/doi.org\/10.4330\/wjc.v12.i7.334","journal-title":"World J Cardiol Jul"},{"issue":"6","key":"3352_CR2","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/17434440.2022.2108319","volume":"19","author":"T Balthazar","year":"2022","unstructured":"Balthazar T, Bennett J, Adriaenssens T. Hemolysis during short-term mechanical circulatory support: from pathophysiology to diagnosis and treatment. Expert Rev Med Devices. 2022;19(6):477\u201388. https:\/\/doi.org\/10.1080\/17434440.2022.2108319","journal-title":"Expert Rev Med Devices Jun"},{"issue":"8","key":"3352_CR3","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.healun.2020.03.010","volume":"39","author":"RL Kormos","year":"2020","unstructured":"Kormos RL, Antonides CFJ, Goldstein DJ, et al. Updated definitions of adverse events for trials and registries of mechanical circulatory support: a consensus statement of the mechanical circulatory support academic research consortium. J Heart Lung Transpl. 2020;39(8):735\u201350. https:\/\/doi.org\/10.1016\/j.healun.2020.03.010","journal-title":"J Heart Lung Transpl Aug"},{"issue":"4","key":"3352_CR4","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.jacc.2009.03.055","volume":"21","author":"FD Pagani","year":"2009","unstructured":"Pagani FD, Miller LW, Russell SD, et al. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol. 2009;21(4):312\u201321. https:\/\/doi.org\/10.1016\/j.jacc.2009.03.055","journal-title":"J Am Coll Cardiol"},{"issue":"23","key":"3352_CR5","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1056\/NEJMoa0909938","volume":"03","author":"MS Slaughter","year":"2009","unstructured":"Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;03(23):2241\u201351. https:\/\/doi.org\/10.1056\/NEJMoa0909938","journal-title":"N Engl J Med Dec"},{"issue":"12","key":"3352_CR6","doi-asserted-by":"publisher","first-page":"e251","DOI":"10.1097\/MAT.0000000000001712","volume":"01","author":"I Salas de Armas","year":"2022","unstructured":"Salas de Armas I, Bergeron A, Bhardwaj A, et al. Surgically implanted Impella device for patients on impella CP support experiencing refractory hemolysis. ASAIO J. 2022;01(12):e251\u20135. https:\/\/doi.org\/10.1097\/MAT.0000000000001712","journal-title":"ASAIO J Dec"},{"issue":"12","key":"3352_CR7","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1016\/j.healun.2015.08.018","volume":"34","author":"MB Anderson","year":"2015","unstructured":"Anderson MB, Goldstein J, Milano C, et al. Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transpl. 2015;34(12):1549\u201360. https:\/\/doi.org\/10.1016\/j.healun.2015.08.018","journal-title":"J Heart Lung Transpl Dec"},{"issue":"3","key":"3352_CR8","doi-asserted-by":"publisher","first-page":"e4691","DOI":"10.1016\/j.ahj.2006.05.031","volume":"152","author":"D Burkhoff","year":"2006","unstructured":"Burkhoff D, Cohen H, Brunckhorst C, O\u2019Neill WW, Group TI. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006;152(3):e4691\u20138. https:\/\/doi.org\/10.1016\/j.ahj.2006.05.031","journal-title":"Am Heart J Sep"},{"issue":"2","key":"3352_CR9","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/aor.13319","volume":"43","author":"ML Esposito","year":"2019","unstructured":"Esposito ML, Morine KJ, Annamalai SK, et al. Increased plasma-free hemoglobin levels identify hemolysis in patients with cardiogenic shock and a trans valvular micro-axial flow pump. Artif Organs. 2019;43(2):125\u201331. https:\/\/doi.org\/10.1111\/aor.13319","journal-title":"Artif Organs Feb"},{"key":"3352_CR10","doi-asserted-by":"publisher","unstructured":"Nakamura M, Imamura T, Hida Y, Kinugawa K. Pulmonary artery pulsatility index and hemolysis during Impella-incorporated mechanical circulatory support. J Clin Med. 2022;23(5). https:\/\/doi.org\/10.3390\/jcm11051206","DOI":"10.3390\/jcm11051206"},{"issue":"14","key":"3352_CR11","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1161\/CIRCULATIONAHA.112.098194","volume":"02","author":"WW O\u2019Neill","year":"2012","unstructured":"O\u2019Neill WW, Kleiman NS, Moses J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;02(14):1717\u201327. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.112.098194","journal-title":"Circulation Oct"},{"key":"3352_CR12","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ahj.2022.08.011","volume":"254","author":"NK Kapur","year":"2022","unstructured":"Kapur NK, Kim RJ, Moses JW, et al. Primary left ventricular unloading with delayed reperfusion in patients with anterior ST-elevation myocardial infarction: rationale and design of the STEMI-DTU randomized pivotal trial. Am Heart J. 2022;254:122\u201332. https:\/\/doi.org\/10.1016\/j.ahj.2022.08.011","journal-title":"Am Heart J Dec"},{"issue":"2","key":"3352_CR13","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1016\/j.jtcvs.2012.01.067","volume":"145","author":"BP Griffith","year":"2013","unstructured":"Griffith BP, Anderson MB, Samuels LE, Pae WE, Naka Y, Frazier OH. The RECOVER I: a multicenter prospective study of Impella 5.0\/LD for postcardiotomy circulatory support. J Thorac Cardiovasc Surg. 2013;145(2):548\u201354. https:\/\/doi.org\/10.1016\/j.jtcvs.2012.01.067","journal-title":"J Thorac Cardiovasc Surg Feb"},{"key":"3352_CR14","unstructured":"Malinauskas R, Rinaldi J, Jamiolkowski M, Lu Q. In vitro dynamic hemolysis testing of blood pumps: updating the ASTM F1841 testing standard. 2021 FDA Science Forum: fda.gov; 2021."},{"key":"3352_CR15","doi-asserted-by":"publisher","first-page":"391398820909843","DOI":"10.1177\/0391398820909843","volume":"04","author":"N Roberts","year":"2020","unstructured":"Roberts N, Chandrasekaran U, Das S, Qi Z, Corbett S. Hemolysis associated with Impella heart pump positioning: in vitro hemolysis testing and computational fluid dynamics modeling. Int J Artif Organs. 2020;04:391398820909843. https:\/\/doi.org\/10.1177\/0391398820909843","journal-title":"Int J Artif Organs Mar"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-025-03352-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-025-03352-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-025-03352-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T01:49:46Z","timestamp":1740793786000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-025-03352-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3352"],"URL":"https:\/\/doi.org\/10.1186\/s13019-025-03352-7","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,1]]},"assertion":[{"value":"1 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of the University of Southern California (IRB # HS-23-00521) and the need for consent was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr Raymond Lee has received speaker honoraria from Abiomed, Abbott, and Edwards Lifesciences. The other authors declare they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"143"}}