Background and aim: To review the various concepts, surgical experiments, and actual procedures performed for the treatment of ischemic heart disease, which eventually led to the evolution of direct coronary artery bypass surgery. Methods: References were collected from original articles and through pubmed search. Results: Various concepts and procedures were introduced, all with the aim of increasing myocardial blood flow and relief of angina. These included creation of vascular adhesions, denervation, thyroidectomies, using other organs for providing blood supply, and intramyocardial implantation of bleeding systemic arteries. Conclusion: Historically various innovative concepts existed and a variety of procedures were performed for treating ischemic myocardium, with variable results. These procedures continued till the evolution of direct coronary artery bypass grafting.