Commentary: Preemptive left ventricular unloading in high-risk cardiac operations—uncertain risk/benefit relationships, but promising!

Preemptive Impella 5.5 insertion to reduce operative risk in high-risk cardiac surgery: A case report

“…Currently, use of the Impella 5.5 in patients is mostly post hoc as bridge to recovery or bridge to transplant in patients with postoperative complications [ 13 ]. There is an opinion that the Impella 5.5 has been used for preemptive ventricular unloading and that prophylactic use of the Impella device to limit left ventricular dysfunction during and following high-risk cardiac operations would be a new use of this device [ 14 ].…”

“…The preemptive use of the Impella device to prophylactically reduce the left ventricular work in high-risk patients is a new and appealing idea that needs to be backed by evidence. The evidence to support this use may only be obtained by experiential observations and anecdotal reports [ 14 ]. The Impella Protected Cardiac Surgery Trial is intended to test the feasibility of enrolment for clinical trial.…”