Navin Kapur, MD, discusses clinical evidence for “on-pump” complex PCI, especially related to patients with heart failure. He reviews data supporting the clinical rationale for revascularization in heart failure and looks at criteria associated with surgical ineligibility, emphasizing that today many of these patients are candidates for potential high-risk or complex PCI. He briefly reviews PROTECT II, PROTECT III and RESTORE EF data and encourages physicians to enroll patients in PROTECT IV. “If your focus is myocardial recovery, optimization of patient outcomes, reducing the burden of drugs or devices that patients may subsequently receive for heart failure, this is one option for those patients.”