Direct Aortic Impella 5.5 in Post-Cardiotomy Shock

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Postcardiotomy cardiogenic shock presents a complex clinical challenge that demands prevention, timely recognition, and early consideration of mechanical circulatory support (MCS). Traditional MCS options accessible to most surgeons, including the intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), are significantly limited—either by providing inadequate cardiac support or, in the case of VA-ECMO, by imposing substantial afterload on the heart, leading to left ventricular distention, pulmonary edema, and impaired myocardial recovery. The Impella 5.5 device offers active left ventricular unloading and forward flow of up to 5.5 liters per minute, promoting myocardial recovery while maintaining systemic perfusion.  

In this video, the authors followed the case of a patient who underwent high-risk coronary artery bypass grafting and developed severe postoperative left ventricular stunning with no viable peripheral vascular access options. He was successfully supported using direct aortic Impella 5.5 insertion, which led to hemodynamic stabilization, myocardial recovery, and device explantation. Through this patient case, the authors present a detailed, step-by-step demonstration of the direct aortic Impella 5.5 insertion technique, highlighting key technical pearls and optimal device positioning. The goal of this presentation is to equip and educate surgeons with a practical, reproducible technique that enables them to confidently support high-risk patients through life-saving cardiac surgery. 

References

1. Anderson M, Smith D, Kane P, Lee R, Khalpey Z, Williams J. Impella 5.5 direct aortic implant and explant techniques. Ann Thorac Surg. 2021;111(4):1420-1426. doi:10.1016/j.athoracsur.2020.09.069.

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