Patients with multiple and peripherial coronary stenosis are not suitable for direct coronary artery surgery. For these patients a new surgical myocardial revascularization was developed. This new surgery was adopted on 5 patients from May 1993 through May 1995. The operation consisted in the grafting of a free skeletal muscle flap onto the anterior wall of the heart (musculus-latissimus-dorsi). The flap artery was implanted into the aorta, the venous flow was directed into the right atrium. All patients were about 3 weeks after the intervention free from angina. The postoperative bicycle ergometry showed no signs of ischemic ST-segment changes, meanwhile the preoperative ergometry evinced signs of ischemic ST-segment changes in almost all patients. Angiographically a patent anastomosis of the flap artery implanted into the aorta was found as well as a good contrast of the graft. Thus, "indirect myocardial revascularization" may be a surgical alternative treatment for patients suffering from therapy refractory ischemic heart disease.