Building Equitable Access to Mechanical Circulatory Support in Latin America: Reflecting on the Accomplishment of Utilizing the First Impella 5.5 p-VAD in Mexico.

Mechanical circulatory support (MCS) has transformed the management of advanced heart failure (HF) and cardiogenic shock (CS), yet access remains profoundly unequal across healthcare systems. Following regulatory approval in Mexico, our institution performed the first Impella 5.5 implantation in Latin America in a patient undergoing high-risk Bentall surgery. Pre-emptive temporary MCS (t-MCS) enabled hemodynamic stabilization, recovery of end-organ function, optimization of medical therapy, mobilization, and rehabilitation. At 6-month follow-up the patient was in NYHA class I with recovery of left ventricular ejection fraction (LVEF) from 30% to 56%. Beyond the clinical outcome, this experience highlights both what is possible and four major barriers to expanding MCS in Latin America: regulatory delays, financial constraints, the need for multidisciplinary HF and CS programs, and the scarcity of region-specific evidence. Addressing these disparities will require coordinated international action, including a consortium focused on global advanced HF inequity, multinational data platforms, exchange of cost-effective regional solutions, and streamlined regulatory pathways for validated technologies. This experience should therefore serve not merely as a technological milestone, but as a catalyst for sustainable and equitable access to advanced HF therapies across Latin America and other resource-constrained healthcare systems.