Cardiopulmonary bypass (CPB) allows operations on the heart in a motionless and bloodless field while reducing cardiac workload and sustaining systemic and coronary perfusion. Failure to wean from CPB remains a significant problem. Results from recent large registry data have shown dramatic improvement in the survival following ventricular assistance for post cardiotomy failure if instituted early. We show how post-cardiotomy heart failure can be successfully treated by proactive use of biventricular assist devices (BIVAD).