How do surgeons decide when to place an Impella 5.5 before valve surgery?

In this discussion, Dr. Roland Hernandez walks through his operative approach with Dr. Chris Brown, covering:

Patient selection: when balloon pump isn’t enough support

Step-by-step technique for direct aortic Impella 5.5 insertion

How to tunnel and remove the graft safely

Technical pearls for cross-clamp position and avoiding flooding

Strategies for weaning from bypass to Impella

Common hazards: wire and catheter challenges for surgeons

Why mobilization is critical and when Impella CP isn’t enough

This case-based conversation offers a rare surgeon-to-interventionalist perspective on advanced mechanical circulatory support.

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Chapters:

00:00 – Intro & guest background

00:45 – Patient case: severe LV dysfunction, AI + MR

02:10 – Why Impella 5.5 over balloon pump

03:20 – Preemptive strategy & surgical planning

03:40 – Direct aortic Impella 5.5 implantation technique

04:45 – Graft tunneling, closure, and removal details

06:20 – Operative sequence & bypass setup

08:10 – Positioning, cross-clamp, and cannulation pearls

09:00 – Valve replacement + Impella insertion steps

10:20 – Weaning from bypass to Impella support

12:00 – Technical challenges: wires & catheters

13:20 – Axillary vs supraclavicular approach considerations

14:30 – Hazards of clamp position & LV flooding

15:45 – Manipulating the device intra-op

16:10 – Deciding level of support: index, EF, gestalt

17:20 – Post-op outcomes, shock scenarios, and red flags

18:40 – Mobilization benefits: why 5.5 beats CP

20:00 – Closing thoughts & key lessons

#Impella #MechanicalSupport #CardiacSurgery #AVR #InterventionalCardiology #TAVR #HeartFailure #MCS #Impella55 #MurmurMD