Advanced Preconditioning: Impella 5.5 Support for Decompensated Heart Failure Before Left Ventricular Assist Device Surgery

Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, and available devices and surgical techniques have strongly evolved over time. Adequate recompensation of patients before surgery is important for optimal surgical outcomes. However, patients with terminal heart failure frequently suffer from cardiorenal syndrome, which complicates recompensation by medical means. Here, we report on the use of an Impella 5.5 microaxial pump for supporting a patient with severely decompensated heart failure before LVAD implantation, which resulted in hemodynamic stabilization and effective recompensation prior to surgery. •Temporary MCS with microaxial pumps unloads heart, lungs and end organs in advanced heart failure and shock.•Temporary MCS helps recompensating patients before LVAD surgery.•The Impella 5.5 offers more than 5 L/min blood flow and thereby serves as a true temporary VAD.•Temporary MCS should be considered early, if recompensation by medical means proves ineffective.