Pratik Sandesara, MD, presents a complex case requiring escalation to Impella 5.5® with SmartAssist® at CAMP COMP in October 2022.

The patient in the case review is a 76-year-old male presenting for pre-renal transplant cardiac evaluation with symptoms of dyspnea on exertion and NYHA class III heart failure. He has heavily calcified three-vessel coronary disease as well as moderate mitral valve regurgitation and severe aortic stenosis. The case is sent for heart team discussion and the patient opts for coronary artery bypass surgery and aortic valve replacement. However, two days prior to planned surgery the patient is admitted with acute decompensated heart failure and progressive cardiogenic shock requiring inotropic and vasopressor support and continuous renal replacement therapy (CRRT).