Aim. To study the myocardial functional state in early postoperative period using different methods of coronary artery bypass grafting and to assess the role of apoptosis mechanisms in development of postoperative myocardial dysfunction. Material and methods. The study included 74 patients with coronary artery disease who underwent CABG surgery. The patients were divided into 4 groups depending on the method and volume of surgery: group 1 (7 patients) — minimally invasive myocardial revascularization (off-pump surgery without CPB and cardioplegia under normothermia); group 2 (36) — CABG surgery under normothermia and parallel CPB; group 3 (12) — CABG under CPB, hypothermia (28 °C) and pharmaco-cold cardioplegia; group 4 (19) — CABG surgery and concomitant cardiac surgery (postinfarction LV aneurysm resection, heart valve surgery) under CPB, hypothermia (28 °C), and pharmaco-cold cardioplegia. Segmental LV function in 16 standard segments and RV in three segmentsof free lateral wall were assessed using tissue Doppler imaging. On-line calculation of parameters was performed preoperatively, at 12 hours and 9 days after surgery. Antioxidant enzyme superoxide dismutase, markers of apoptosis including Bcl-2 protein, cytochrome C, markers of myocardial injury such as troponin I, CK-MB at baseline, at 6 and 24 hours after surgery were determined. Results. Comparison of myocardial functional state has shown that the best indicators were determined in group of minimally invasive myocardial revascularization according to tissue Doppler techniques. Analysis of oxidative stress, markers of myocardial apoptosis and necrosis in early postoperative period showed that patients with coronary heart disease operated under CPB and cardioplegia had marked impairment of antioxidant protection, decreased expression of anti-apoptotic Bcl-2 protein, trend to an increase of cytochrome C release, higher levels of myocardial damage markers in comparison with off-pump surgery. It points on the relationship between oxidative stress with apoptosis and decrease of postoperative myocardial contractility. Correlation of apoptosis and myocardial damage markers with development of acute heart and multiple organ failure in the early postoperative period was revealed: cytochrome C (r=0.47; p=0.009); troponin I (r=0.65; p=0.0001; r=0.67; p=0.0001); CK-MB (r=0.58; p=0.0004; r=0.56; p=0.001). Conclusion. Apoptosis is one of the mechanisms of myocardial dysfunction after cardiac surgery. Researches in this area should potentially improve myocardial protection including the development of drugs directed to various mechanisms of apoptosis.