{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:13:21Z","timestamp":1788351201393,"version":"build-2803163510"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    The Impella 5.5 is an axillary mechanical circulatory support device used in patients with cardiogenic shock, but those with small left ventricular (LV) cavities may be at risk for suction events, hemolysis, malpositioning, hypoperfusion, and LV injury. Informally accepted guidelines, extrapolated from durable LVAD studies, suggest a minimum left ventricular internal dimension in diastole (LVIDd) of 58\u2005mm, with some clinical practices using a more stringent \u226452\u2005mm cutoff. We retrospectively analyzed 154 consecutive patients supported with Impella 5.5 between January 2020 and December 2024. Overall, 38 patients had an LVIDd \u226458\u2005mm, and 116 had an LVIDd &amp;gt;58\u2005mm; a key subgroup of 21 patients presented with a very small LVIDd of \u226452\u2005mm]. Baseline demographics, comorbidities, body mass index, and renal function were similar [across groups], although those with larger LVIDd had lower ejection fractions (16% vs. 24%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Median support duration was 24 days in all groups, and pre- and post-implant hemodynamic and laboratory improvements were comparable. Rates of transplantation (79% vs. 90%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.088) and LVAD implantation (2% vs. 6%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.159) did not differ significantly in the \u226458\u2005mm cohort. Notably, within the \u226452\u2005mm subgroup, 90-day survival remained high at 90.5% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.336), with significant improvements in right atrial pressure (17 to 10 mmHg,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.041), mean pulmonary artery pressure (36 to 26 mmHg,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008), and eGFR (45 to 57\u2005mL\/min\/1.73m\n                    <jats:sup>2<\/jats:sup>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003). Remarkably, native cardiac recovery was observed exclusively in the smaller LV cohorts, occurring in 11% of the \u226458\u2005mm group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003 vs. 0%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003) and reaching 19% in the \u226452\u2005mm group (vs. 0% in larger cavities,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.001), while durable LVAD escalation was entirely avoided in the \u226452\u2005mm cohort (0% vs. 6%). Ninety-day event-free survival was excellent across all cohorts 92% vs. 96% in the primary analysis, with no major device-related complications, suction events, clinically significant hemolysis, bleeding, stroke, or escalation to Bi-VAD support. These findings strongly support the safety and feasibility of Impella 5.5 in extremely constrained, small LV cavities.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2026.1893068","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:27:58Z","timestamp":1785911278000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Natural history of Impella 5.5 in patients with cardiogenic shock and small left ventricular cavities"],"prefix":"10.3389","volume":"13","author":[{"given":"Aarti","family":"Desai","sequence":"first","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Mautong","sequence":"additional","affiliation":[{"name":"Internal Medicine Resident, John H. Stroger Jr. Hospital of Cook County","place":["Chicago, IL, United States"]},{"name":"School of Health, Universidad Esp\u00edritu Santo-Ecuador","place":["Samborond\u00f3n, Guayas, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wlodkowski","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Klingbeil","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Peri-operative Medicine, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cetin","family":"Alak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Uludag University School of Medicine","place":["Bursa, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Peri-operative Medicine, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archer","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Peri-operative Medicine, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Nativi","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Goswami","sequence":"additional","affiliation":[{"name":"Division of Heart Failure and Transplantation, Mayo Clinic","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1407552","DOI":"10.3389\/fcvm.2024.1407552","article-title":"Case report: unmasking sustainable left ventricular recovery in chronic heart failure with axillary temporary mechanical circulatory support","volume":"11","author":"Desai","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"ezab480","DOI":"10.1093\/ejcts\/ezab480","article-title":"The impact of left ventricular size on outcomes after centrifugal-flow left ventricular assist device implantation","volume":"62","author":"Molina","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"100051","DOI":"10.1016\/j.jhlto.2023.100051","article-title":"Impella 5.5 in left ventricular noncompaction syndrome as bridge to heart transplant","volume":"4","author":"Sharma","year":"2024","journal-title":"JHLT Open"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S439","DOI":"10.1016\/j.healun.2025.02.949","article-title":"Female patients bridged to heart transplantation using the Impella 5.5 as temporary mechanical circulatory support","volume":"44","author":"Shapiro","year":"2025","journal-title":"J Heart Lung Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"S272","DOI":"10.1016\/j.healun.2025.02.568","article-title":"Early pulmonary vascular resistance recovery with Impella 5.5 before heart transplantation","volume":"44","author":"Goswami","year":"2025","journal-title":"J Heart Lung Transplant"},{"key":"B6","doi-asserted-by":"publisher","first-page":"19671","DOI":"10.1038\/s41598-023-46901-7","article-title":"Axillary mechanical circulatory support improves renal function prior to heart transplantation in patients with chronic kidney disease","volume":"13","author":"Jang","year":"2023","journal-title":"Sci Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"ehae666.1121","DOI":"10.1093\/eurheartj\/ehae666.1121","article-title":"Extending the window in clinical decision making: the role for Impella 5.5 in cardiogenic shock","volume":"45","author":"Desai","year":"2024","journal-title":"Eur Heart J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1097\/mat.0000000000000798","article-title":"Small left ventricular size is an independent risk factor for ventricular assist device thrombosis","volume":"65","author":"Chivukula","year":"2019","journal-title":"ASAIO J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"100120","DOI":"10.1016\/j.jscai.2022.100120","article-title":"B-13 | Impella cardiac perforation events - A report from FDA MAUDE database","volume":"1","author":"Sheikh","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1893068\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:19:01Z","timestamp":1788347941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1893068\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":9,"alternative-id":["10.3389\/fcvm.2026.1893068"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1893068","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"1893068"}}