Preemptive Direct Ascending Aorta Insertion of Impella 5.5 with SmartAssist in Patients with Severely Impaired Left Ventricular Ejection Fraction and Acute Pulmonary Edema Undergoing Cardiac Surgery

All articles of this category (opens in new window) Background: lschemic cardiomyopathy is a leading cause of acute heart failure and mortality. This study reports a series of CABG ± valve procedures receiving preemptive insertion of Impella 5.5 with SmartAssist device through the ascending aorta intraoperatively to prevent the onset of postcardiotomy cardiogenic shock after cardiac surgery. Methods: Between January and June 2025, six patients underwent lmpella 5.0/5.5 Implantation at our center due to preoperative valvar and/or ischemic cardiogenic shock with low LVEF (40%), and had no requirements for cardiac resynchronization therapy. Conclusion: Beyond myocardial recovery, lmpella 5.5 with Smart Assist support ensures rapid pulmonary recovery by unloading the left heart and maintaining peripheral perfusion and adequate renal function. Early preemptive intraoperative direct ascending aorta implantation of the lmpella 5.5 with SmartAssist ensures unremarkable neurological outcome, pulmonary recovery, and better survival compared to postoperative transaxillary implantation. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany