{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:07:38Z","timestamp":1778684858383,"version":"3.51.4"},"reference-count":17,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Patients with left ventricular dysfunction undergoing cardiac surgery face a heightened risk of perioperative complications, including postcardiotomy shock (PCS). Conventional management with inotropes and vasopressors can exacerbate end-organ dysfunction, underscoring the need for alternative strategies. The planned use of mechanical circulatory support (MCS) devices, such as the Impella, offers a proactive approach to mitigating PCS in high-risk patients. This study presents our early experience at Johns Hopkins with planned Impella utilization in high-risk cardiac surgery. We detail our risk stratification methodology, patient selection criteria, and perioperative management strategies. Our proposed risk stratification scoring system incorporates surgical intent, preoperative myocardial function, anticipated postoperative course, and exit strategy to identify optimal candidates for perioperative MCS. We describe the intraoperative central placement technique for the Impella 5.5, perioperative management protocols\u2014including anticoagulation strategies and weaning protocols\u2014and postoperative device extraction. A retrospective review of our first 11 consecutive patients with severely reduced left ventricular ejection fraction (&lt;30%) who underwent Impella-assisted cardiac surgery demonstrated favorable outcomes, with no postoperative mortality and a two-year follow-up. Our findings suggest that planned Impella use in high-risk cardiac surgery is both feasible and beneficial. However, further studies are necessary to validate these results, assess long-term outcomes, and evaluate cost-effectiveness.<\/jats:p>","DOI":"10.3390\/jcdd13050193","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:50:01Z","timestamp":1777618201000},"page":"193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How I Do It: Perioperative Use of Micro-Axial Pumps in High Risk Coronary Artery Bypass Grafting: The Early Johns Hopkins Experience"],"prefix":"10.3390","volume":"13","author":[{"given":"Salman","family":"Zaheer","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Penn State Milton S. Hershey Medical Center, 200 Campus Dr., Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Aref","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4135-7321","authenticated-orcid":false,"given":"Oldrich","family":"Virag","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5454-1438","authenticated-orcid":false,"given":"Bogdan","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chetan","family":"Pasrija","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Polanco","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza","family":"Aziz","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2365-3093","authenticated-orcid":false,"given":"Ahmet","family":"Kilic","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1053\/j.jvca.2023.09.011","article-title":"Postcardiotomy Shock Syndrome: A Narrative Review of Perioperative Diagnosis and Management","volume":"37","author":"Richter","year":"2023","journal-title":"J. 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