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lschemic heart failure causes high morbidity/mortality when associated with acute myocardial infarction.Off Pump Revascularization to salvage ischemic myocardium in these patients can decrease morbidity associated with conventional cardiopulmonary bypass and hypothermia in these high risk patients.From January 2005 to June 2010 we performed OPCAB in 5542 patients requiring Coronary Revascularization and 816 among them had ischemic left ventricular failure (LVEF < 35%).