Concurrent, independent clinical series at Yale University and the University of Virginia demonstrate an important role for CABG in patients with advanced ischemic cardiomyopathy. It is found that CABG can be performed safely in these patients, both angina and congestive heart failure states improve, ejection fraction increases substantially, and good long-term longevity is achieved. Despite prior concerns, the internal mammary conduit can be used safely in these patients. It appears that CABG serves to protect viable noninfarcted muscle and to recruit hibernating ischemic muscle. CABG is suggested as an alternative to heart transplantation in this patient group.