The number of coronary patients with impaired left ventricular (LV) systolic function proposed for coronary artery bypass surgery (CABG) has increased in recent years. This combination of coronary artery disease and left ventricular dysfunction is associated with a high post-operative mortality rate.CABG is an interesting alternative that may offer better preservation of post-operative ventricular function in these fragile patients, due to the absence of the inflammatory effects of extracorporeal circulation. However, this technique often leads to incomplete myocardial revascularization and a higher late mortality rate than in patients operated on under CEC. Revascularization surgery techniques are currently undergoing considerable development, especially in the case of failing hearts. One of the current challenges is to reduce the post-operative morbidity and mortality rate, which is still higher than for surgery on a heart with good systolic function.