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The role of coronary artery bypass grafting in the treatment of patients with ischemic cardiomyopathy and heart failure has not been clearly established. A few studies have suggested that patients with multivessel coronary artery disease and severe left ventricular dysfunction may have superior outcomes with surgery than with medical management. In this report we describe three patients with multivessel coronary artery disease, severe ischemic cardiomyopathy and advanced heart failure who experienced full and sustained clinical and echocardiographic recovery with medical management alone, without revascularization. These cases constitute "proof of concept" indicating that aggressive medical management may be an appropriate first-line therapy for such patients.