{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:08:13Z","timestamp":1774627693214,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Ischemic cardiomyopathy is defined as coronary artery disease accompanied by left ventricular dysfunction with an ejection fraction equal to or less than 40%. The substrate of ischemic cardiomyopathy is heterogeneous, characterized by the coexistence of normal, stunned, hibernating, and scarred myocardium within the same myocardial region. Altogether, these components may represent different phases of a single pathological process. It is well-established that the assessment of isolated myocardial viability and ischemia alone has failed to reliably guide the indication for coronary artery bypass grafting (CABG). CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity, largely related to the development of postcardiotomy shock. Preoperative optimization with pharmacologic or mechanical circulatory support (MCS) is often essential; the decision requires integrating multiple complex factors, including clinical presentation, response to optimization therapy, myocardial viability, the presence of hibernating or scarred myocardium, left ventricular end-systolic volume index, coronary angiography findings, hemodynamic assessment, and the Pulmonary Arterial Pressure Index score. A preoperative evaluation that incorporates anatomical, morphological, functional, and hemodynamic domains enables more precise selection and timing of MCS. Preemptive left ventricular unloading mitigates the physiological impact of cardiopulmonary bypass, preserves end-organ perfusion, and reduces the need for high-dose vasopressors. However, the risk\u2013benefit ratio remains uncertain and may be associated with serious complications. Careful judgment regarding the indications for MCS has the potential to enhance the safety of CABG in high-risk patients, but robust, long-term, prospective studies are needed to determine its true impact on clinical outcomes. In this review, we will examine the indications and criteria for the use of MCS in patients with advanced ischemic cardiomyopathy, as well as the various devices available for preoperative or intraoperative support, including technical considerations, advantages and disadvantages, and associated complications.<\/jats:p>","DOI":"10.3390\/medicina62040638","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:33:33Z","timestamp":1774622013000},"page":"638","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mechanical Circulatory Support on Coronary Artery Bypass Grafting for Advanced Ischemic Cardiomyopathy: State of the Art"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2026-7231","authenticated-orcid":false,"given":"Erik J.","family":"Orozco-Hernandez","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"Davies","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1434-7123","authenticated-orcid":false,"given":"Sasha Anne","family":"Still","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle W.","family":"Eudailey","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkateswaran","family":"Rajamiyer","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1872-5347","authenticated-orcid":false,"given":"Panos N.","family":"Vardas","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifton T.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Holman","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Cardiac Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","first-page":"e18","article-title":"2021 ACC\/AHA\/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Lawton","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). 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