The elective simple coronary revascularization in the last consecutive 200 patients were analyzed in this study. Despite of the increase in older patients who have more high risk factors, including low left ventricular ejection fraction (LVEF) and multiple vessel disease, there were no operative deaths in the second 100 patients. The use of calcium antagonist in patients with a history of spastic angina eliminated episodes of spastic angina in the perioperative period. In the late postoperative period, there were no cardiac deaths during the 7-year follow-up period. Angina remained in two of three patients with the patent grafts, who had a history of spastic angina. Hyperlipidemia and diabetes mellitus influenced occlusion of the grafts and progression of atherosclerosis of native coronary arteries and then four of five reoperations. Exercise tolerance in patients, even those with preoperative low LVEF, has been improved although their was some increment of left ventricular end-diastolic pressure during exercise. Patency rate in sequential grafting with saphenous vein grafts or internal mammary artery grafts were 92% in the average follow-up period of 11 months. The increase of flow rate with nitroglycerine and atrial pacing in internal mammary artery grafts (IMAG) were comparable with saphenous vein grafts.