Study purpose: To examine the safety of myocardial regeneration by direct epicardial shock wave therapy in combination with coronary artery bypass grafting.

Direct epicardial shock wave therapy: DESWT will be performed in adjunct to a standard CABG procedure. Prior to aortic cross clamping, DESWT will be performed using a CardioGold® CG050 (CRT Cardiac Regeneration Technologies, Woodstock, USA / manufactured by MTS-Europe GmbH, Konstanz, Germany) shock wave therapy device and a specially designed handheld applicator under sterile conditions. Depending on the localisation of the myocardial infarct scar, 290-310 impulses will be applied to the anterior, lateral, or posterior wall. Shock waves will be generated at 1 or 2 Hz in a non ECG triggered fashion, should DESWT result in significant ventricular arrhythmias, ECG gating will be initiated. After completion of DESWT, CABG will be continued in a regular fashion.

Inclusion Criteria:

• Male or female patients above 18 years of age undergoing primary coronary artery bypass grafting.
• Patients have to present with reduced left ventricular function defined as LVEF < 50%.
• Patients have to present with regional left ventricular wall motion abnormalities.
• Patients have to give written informed consent to participate in the study.

Exclusion Criteria:

• Significant concomitant valve disease(except significant valve disease not detected in preoperative cardiac ultrasound that is detected intra-operatively).
• HIV positive patients.
• Hepatitis C positive patients.
• Patients in cardiogenic shock.
• Patients with a contraindication for cardiac MRI.
• Present contraindication for transoesophageal echocardiography (TEE).
• History of significant ventricular arrhythmias, except arrhythmias associated with MI.
• Highly reduced left ventricular function defined as LVEF <30%.
• Present co-morbidity which reduces life expectancy to less than 6 months.
• Presence of ventricular thrombus.
• Presence of a cardiac tumor.
• Pregnancy.