Coronary venous retroperfusion and Intra-Aortic Balloon Pump (IABP) support are methods currently utilized to reduce ischemic damage prior to revascularization of acutely ischemic myocardium. This study was undertaken to determine whether combining coronary venous retroperfusion using Pressure Controlled Intermittent Coronary Sinus Occlusion (PICSO) with the IABP would result in improved salvage of ischemic myocardium. In 40 adult pigs, the second and third diagonal vessels were occluded with snares for 1 1/2 hours followed by 1/2 hours of cardioplegic arrest and 3 hours of reperfusion with the snares released. During the period of coronary occlusion prior to arrest, 10 pigs received the IABP, 10 had PICSO, 10 had PICSO+IABP, while 10 had no intervention (Unmodified). Ischemic damage was assessed by echocardiographic wall motion scores, myocardial pH, and the area of necrosis/area of risk using histochemical staining. Both PICSO and the IABP alone significantly reduced ischemic damage. However, the best wall motion scores, highest pH, and least necrosis was seen in the IABP+PICSO group. We conclude that the combination of coronary venous retroperfusion using PICSO and the IABP results in the most optimal recovery of acutely ischemic myocardium during emergent surgical revascularization.