Due to the increased life expectancy derived from better conditions of life and improved medical technology, interventional cardiologists are facing challenging procedures in older and much more delicate patients, in whom percutaneous coronary intervention is generally considered less dangerous than cardiac surgery. We present two recent cases of high-risk complete myocardial revascularization in patients older than 80 years assisted by the Impella Recover 2.5. In our initial experience this device proved to be relatively easy to set up and hemodynamically useful for patients with left ventricular dysfunction and end-stage coronary atherosclerosis.