Molly Schultheis, MD, a cardiothoracic surgeon at Englewood Hospital and Medical Center in New Jersey, presents a cardiogenic shock case supported with Impella 5.5 at the August 2023 CAMP case competition. The patient is a 72-year-old male who presented to an outside hospital with chest pain, pulmonary edema and congestive heart failure, and he ruled in for NSTEMI. He had low ejection fraction and moderate-to-severe mitral regurgitation. An intra-aortic balloon pump (IABP) was placed, and the patient was transferred to Dr. Schultheis. The patient underwent CABG, mitral valve replacement and left atrial appendage (LAA) clip. Dr. Schultheis determined that the IABP was not providing sufficient support when the patient was weaned off cardiopulmonary bypass, so she implanted Impella 5.5 in the aorta. She describes the Impella 5.5 implant and explant procedures and the benefits of Impella® support in such a complex case.