This Impella skills video demonstrates direct aortic insertion of the Impella 5.5 with SmartAssist. The video is a simplified version of the technique, highlighting the primary steps of the procedure. Note that the vascular graft is not included in the Impella 5.5 with SmartAssist Set-up and Insertion Kit. Abiomed recommends using a Hemashield Platinum® or Vascutek Gelweave™ graft.