Two groups of patients whose ejection fraction was below 0.45, underwent aortocoronary shunting of one to five arteries: patients without myocardial scarry changes (group 1) and those with expansive intra- and transmural myocardial scarry changes (group 2). The latter group was more difficult in terms of coronary bed affection, myocardial contractility and a greater proportion of patients with circulatory insufficiency, which dictated the type of anesthesia, myocardial protection and the surgical techniques in these patients. Aortocoronary shunting is shown to be quite justified and effective in patients with reduced left-ventricular ejection fraction, particularly so in group 1, yet it requires careful selection of patients, provision of adequate myocardial protection and maintenance of myocardial activity at all stages of the intervention.