Aim To investigate the surgical therapy for chronic total occlusion of coronary artery. Methods 753 patients with 928 totally occluded coronary arteries(148 coronary arteries lack of opacification while the other 780 arteries with reverse flow) underwent coronary artery bypass grafting(CABG).A total of 2501 grafts were constructed including 155 placed to coronary endarterectomy(CE) targets and 37 arterialized middle cardiac veins.Blood flow was detected during operation in 31 coronary arteries with no opacification in preoperative angiography,while no blood flow was detected in 75 coronary arteries with opacification in preoperative angiography.Cardiopulmonary bypass was applied in 17 cases because of a poor hemodynamics and 8 of which were assisted with IABP.The other 736 cases underwent OPCAB.CVVHDF was performed for 8 cases. Results All patients survived the operation.In the 152 cases of coronary endarterectomy,2 died after operation because of low cardiac output(1 case) and renal failure(1 case).The other 150 cases were followed up for 1 month to 9 years.One died suddenly 2 years after operation.Angina disappeared completely in 132 cases(88.6%) and 14 patients relieved from angina with NYHA function of stage Ⅰ～Ⅱ.For the other 601 patients,5 died in hospital because of low cardiac output(1 case),renal failure(1 case),perioperative cardiac infarction(1 case) and cerebrovascular accident(1 case).Recovery of cardiac function and freedom from cardiac angina was 99%. Conclusions CABG can be well preferred in patients with total occlusion of coronary arteries.The application of IABP and CVVHDF can improve the prognosis of severe case.It is limited to evaluate totally occluded coronary artery only using coronary angiography,and endoscope or intravascular ultrasound techniques may be helpful.