The present study introduces a novel approach to coronary revascularization through the use of a short term minimally-invasive left ventricular assist device (LVAD) to minimize myocardial injury and eliminate low output state during the perioperative period

Inclusion Criteria:

• Age ≥ 18 years old
• Ejection fraction ≤ 35%
• Symptomatic three vessel Coronary Artery Disease with target vessels that are amenable to bypass (as determined by the operating surgeon) or Left main disease
• Adequate Distal target caliber (as determined by the PI or operating surgeon)

Exclusion Criteria:

• Exclusion criteria will include the existing contraindications to either Impella therapy or OPCABG revascularization:

  • Patients with structural heart disease requiring cardiopulmonary bypass
  • Patients with cardiogenic shock who require a period of short-term mechanical circulatory support
  • Patients with mechanical aortic valve
  • Patients with previous median sternotomy
  • Patients with evidence of non-viability on preoperative cardiac MRI or CT scan
  • Insufficient conduit
  • BMI over 50
  • Suspected or known pregnancy

Patients fitting inclusion criteria will undergo Impella supported OPCABG using coronary shunts. Inclusion criteria will target patients with ischemic cardiomyopathy, similarly defined to the STICH trial which evaluated coronary revascularization in the setting of heart failure (defined by an EF≤35%). Patients would be considered for enrollment in the setting of symptomatic severe multi-vessel coronary artery disease with target vessels that are amenable to bypass (as determined by the operating surgeon).