A 73-year-old male with a history of severe coronary artery disease and prior CABG presented with chest pain and elevated troponins. His workup revealed an ejection fraction of 10-15% and severe native coronary disease as well as stenosis of bypass grafts. He underwent high-risk redo CABG with Impella 5.5 (Abiomed, Danvers, MA) placement. The Impella was removed on postoperative day eight at which time he went into cardiogenic shock from aortic valve leaflet disruption and severe aortic insufficiency. Given that this patient had severe aortic insufficiency and no calcium deposits around the aortic valve annulus a multidisciplinary heart team decided he would be best served by a surgical aortic valve replacement. He was taken back to the operating room for a surgical aortic valve and intra-aortic balloon pump. His postoperative course was complicated by pneumonia, sepsis, and renal failure requiring continuous renal replacement therapy. He was discharged to rehab after 42 days.
