This case study presents a high-risk coronary artery bypass grafting (CABG) patient with a recent anterior wall myocardial infarction and severely impaired left ventricular function. The patient underwent on-pump CABG with prolonged cardiopulmonary bypass support. The management strategy used hybrid mechanical circulatory support, intra-aortic balloon pump, and Impella CP, improved postoperative recovery, and prevented low cardiac output syndrome development.