How do surgeons decide when to place an Impella 5.5 before valve surgery?
In this discussion, Dr. Roland Hernandez walks through his operative approach with Dr. Chris Brown, covering:
Patient selection: when balloon pump isn’t enough support
Step-by-step technique for direct aortic Impella 5.5 insertion
How to tunnel and remove the graft safely
Technical pearls for cross-clamp position and avoiding flooding
Strategies for weaning from bypass to Impella
Common hazards: wire and catheter challenges for surgeons
Why mobilization is critical and when Impella CP isn’t enough
This case-based conversation offers a rare surgeon-to-interventionalist perspective on advanced mechanical circulatory support.
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Chapters:
00:00 – Intro & guest background
00:45 – Patient case: severe LV dysfunction, AI + MR
02:10 – Why Impella 5.5 over balloon pump
03:20 – Preemptive strategy & surgical planning
03:40 – Direct aortic Impella 5.5 implantation technique
04:45 – Graft tunneling, closure, and removal details
06:20 – Operative sequence & bypass setup
08:10 – Positioning, cross-clamp, and cannulation pearls
09:00 – Valve replacement + Impella insertion steps
10:20 – Weaning from bypass to Impella support
12:00 – Technical challenges: wires & catheters
13:20 – Axillary vs supraclavicular approach considerations
14:30 – Hazards of clamp position & LV flooding
15:45 – Manipulating the device intra-op
16:10 – Deciding level of support: index, EF, gestalt
17:20 – Post-op outcomes, shock scenarios, and red flags
18:40 – Mobilization benefits: why 5.5 beats CP
20:00 – Closing thoughts & key lessons
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