The purpose of this investigation is to develop a means to improve the recovery of cardiac metabolism and ventricular function following coronary artery bypass surgery (CABG) in patients with poor preoperative ventricular function (e.g. ejection fraction <40%).

Hypothesis

Insulin added to blood cardioplegia will improve the results of Coronary Artery Bypass Graft by reducing the incidence of low output syndrome (i.e., the requirement for inotropic or balloon pump assistance) in patients with a preoperative ejection fraction <40%.

Inclusion Criteria:

• Patient has been referred for isolated coronary bypass surgery.
• LV grade 3 or 4, LVEF <40% by angio, echo, RNA.

Exclusion Criteria:

• Patient is undergoing reoperative surgery (i.e., has had any previous cardiac surgery)
• Surgeon has planned another procedure in addition to coronary bypass surgery (e.g., valve repair, replacement, ascending aorta repair or replacement, left ventricular aneurysm resection, repair of congenital defect, carotid surgery, repair of abdominal aortic aneurysm).
• Patient is scheduled for minimally invasive surgery.
• More recent assessment of LV function with LV grade 1 0r 2, LVEF>40%.
• 5 or 6 days post MI.