Marisa Cevasco, MD, Kevin Lobdell, MD, Edward Soltesz, MD, and Keki Balsara, MD, discuss using Impella 5.5® with SmartAssist® in patients undergoing high-risk surgical procedures in this lunchtime symposium from the 2024 annual meeting of the Society of Thoracic Surgeons (STS). Dr. Cevasco provides an overview of Impella 5.5® adoption and presents data from studies using Impella to support post-cardiotomy cardiogenic shock (PCCS). Dr. Lobdell presents data demonstrating that early proactive, rather than reactive, use of temporary MCS can lead to better outcomes after cardiac surgery. Dr. Soltesz, MD, discusses the Impella-Protected Cardiac Surgery Trial (IMPACT) and use of Impella 5.5 as an adjunctive measure for managing mechanical complications of myocardial infarction (MI). Keki Balsara, MD, describes an alternative access approach for Impella 5.5.