After more than ten years of clinical application, direct myocardial revascularization with saphenous or mammary vein grafts is becomining one of the most common types of elective major surgery performed in the United States. The need for and the results of revascularization surgery are determined by cine coronary arteriography. The principles on which this type of surgery is based are simple. Critical occlusion of a coronary artery may produce an arteriographically identifiable area of myocardial perfusion deficit in the left ventricle. The functional demand for blood that results is usually manifested by anginal pain. When the occlusion is reduced by rest and administration of vasodilators, the immediate threat of infarction is alleviated. When pain persists in spite of treatment, direct revascularization surgery should be considered. This type of surgery need not involve ultrasophisticated adjuncts. Some of these adjuncts increase morbidity and contribute appreciably to the cost of operation and hospitalization. The record of myocardial revascularization suggests that the surgical treatment of coronary artery disease can and should be done in qualified community hospitals.