Purpose — to substantiate the safety and efficacy of transmyocardial laser revascularization in combination with coronary artery bypass grafting in those patients who whould not be able to gain complete revascularization through ragular coronary bypass grafting. Mathirial and methods. The results of treatment of 60 patients in the period from 2007 to 2013 who underwent coronary artery bypass grafting in combination with transmyocardial laser revascularization in ischemic areas not amenable to shunting were retrospectively analyzed. Mean age 65.9±7.3 years (max 81 years). All patients had angina pectoralis of III—IV functional class. Anamnesis morbi revealed myocardial infarction in 70% of the patients. In the long-term period 55 patients (91.6%) were observed. The follow — up period was 7.5±0.9 years (max 10 years). Results. Hospital mortality rate was 1.5% (2/60). Long-term survival — 91.6%. Stenocardia functional class lovered 2 ranks down. All patients showed an increase in exercise tolerance; in 12 months of observation they made the considerable improve on the treadmill from 56.8±3.4 to 85.6±4.3 W in single workout. Survival rate 7.5±0.9 years past surgery reached 91.6% (n=55). Conclusion. transmyocardial revascularization in combination with coronary artery bypass grafting in high-risk patients with diffuse coronary arteries atherosclerosis contributed to an increase in exercise tolerance, symptoms reduction and provided an acceptable long term quality of life.