For several decades, the anatomic degree of coronary artery stenosis (CAS) has been the sole criterion for determining target vessels for coronary revascularization. There have been many studies evaluating the impact of functional ischemia-based revascularization during percutaneous coronary intervention. However, only limited data are available for this issue in the surgical setting. Nowadays, there has been growing interest regarding the impact of the functional significance of CAS on the results after surgical revascularization. Therefore, in this narrative review, the benefits and shortcomings of functional ischemia-guided coronary artery bypass grafting (CABG) are summarized, and available literature evaluating the impact of functional ischemia-guided CABG on clinical and angiographic outcomes are reviewed.Because only limited data have been published for this issue, future studies with large patient cohort might be needed to draw definite conclusions.