Twenty-one patients undergoing a coronary artery bypass graft operation for the third time were retrospectively reviewed to assess the factors of importance in the management of these patients. The study spans 5.8 years and represents 6.2% of coronary bypass reoperations and 0.6% (21/3500) of total bypass operations during that time. The indication for reoperation was disabling angina pectoris not responsive to medical treatment in 20 patients (95%) and unstable angina pectoris with an intraaortic balloon pump present in one patient (5%). Median sternotomy was used in all and cardiopulmonary bypass in all but one who had an interposition vein graft without cardiopulmonary bypass. Internal mammary artery grafting was used in 86% of patients. There were no operative deaths. One patient died 12 months after his operation. Four patients (19%) required intraaortic balloon pump support postoperatively for up to 6 days. There were no reexplorations for bleeding. One patient required sternal rewiring for an early dehiscence (5%). Respiratory failure occurred in eight patients (38%). Average stay was 4.4 days in the intensive care unit and postoperative hospital stay was 13.7 days. No new Q waves were noted postoperatively. Detailed follow-up was obtained on 18 of the 20 survivors (90%). The two remaining are alive but declined interview efforts. All patients interviewed reported feeling subjectively better than before operation; however 61% of these interviewed continue to have some degree of angina pectoris. One patient has had a late myocardial infarction. This report suggests that the third time coronary bypass can be done with good results when myocardial revascularization is indicated.