Ahmad Zeeshan, MD, a cardiothoracic surgeon at Advent Health Orlando, presents a case supported with Impella 5.5 with SmartAssist at the August 2023 CAMP case competition. The patient is a 70-year-old female who presented to the ED with worsening heart failure and deep vein thrombosis (DVT). Angiography revealed non-ischemic cardiomyopathy and chest CTA revealed an aortic aneurysm, aortic root dilation and a large hiatal hernia. The surgical procedure entailed an aortic root and hemi-arch replacement with Impella 5.5 hemodynamic support for low ejection fraction. Dr. Zeeshan describes Impella 5.5 placement through the aortic graft and discusses Impella removal and important considerations for avoiding and minimizing complications.