Impella 5.5 Direct Aortic Implant and Explant Techniques.

The Impella 5.5 with SmartAssist system (Abiomed, Danvers, MA) is approved for the treatment of cardiogenic shock after acute myocardial infarction, cardiac surgery, or in the setting of cardiomyopathy. Designed for full circulatory support and left ventricular unloading the system comprises a catheter-based microaxial pump placed across the aortic valve, pulling blood from the left ventricle and into the ascending aorta. Implantation can be approached through the axillary artery or directly into the aortic root. We present several technical options for implanting, tunneling, and explanting the system using the direct aortic approach and allowing for bedside removal.