Marisa Cevasco, MD MPh, presents an Impella 5.5 with SmartAssist case from her shock team at a gathering of East Coast fellows. Dr. Cevasco is a cardiothoracic surgeon at Penn Heart and Vascular Center. The case she presents underwent urgent transcatheter aortic valve replacement (TAVR) and then required post-TAVR Impella 5.5 as a bridge to a durable left ventricular assist device (LVAD). Dr. Cevasco describes the case and explains how her shock team works at Penn and how she evaluates patients for Impella 5.5. She provides surgical details for Impella 5.5 insertion and addresses a question about device and graft removal.