Background In the present study 15 years of experience with surgical coronary artery bypass grafting (CABG) in patients with left ventricular (LV) dysfunction were retrospectively analyzed. Methods and Results Between August 1990 and May 2005, a total of 120 patients with severe LV dysfunction (LV ejection fraction (EF) ≤30%) caused by coronary artery disease underwent CABG (mean age 60.3 years, 94 males) Among the 120 patients, 102 had 3-vessel or left main disease. Mean LVEF was 23.5%, and 75% of patients were New York Heart Association functional class III or IV. CABG was performed in all patients with a mean of 2.9 distal grafts/patient. There were 13 hospital deaths (11%). Mean LVEF improved to 32% postoperatively, and further improved to 39% at a mean follow-up of 57.6 months (p<0.05). During the follow-up period, 2 cardiac-related deaths occurred. Kaplan-Meier survival rates at 1, 5 and 10 years were 87.7%, 80.9%, and 44.4%, respectively, and respective freedom from cardiac-related event rates were 96.5%, 90.3% and 63.5%. Conclusions CABG in patients with severe LV dysfunction provides optimal survival with an improved EF and functional state, and may provide a good alternative to transplantation in selected patients. (Circ J 2007; 71: 1862 - 1866)