Patients with congestive heart failure commonly display dysynchronous contraction patterns and weakened cardiac performance. Cardiac resynchronization therapy from biventricular pacing has been proven effective using coronary sinus cannulation or a less common surgical approach. In this study, the beneficial effects of implanting biventricular leads using the surgical approach for New York Heart Association functional class 3 or 4 patients (mean, 3.4 +/- 0.5) were evaluated in 19 patients (17 male, 2 female). Pacing thresholds after 2 years were deemed favorable (left ventricle, 2.1 +/- 0.8 V; right ventricle, 1.1 +/- 0.4 V). Dobutamine therapy was no longer needed in 2 patients after they underwent biventricular pacing. No mortality or morbidity resulted from the procedure, and 2 patients were readmitted to the hospital, once each after the procedure over the 2-year follow-up period. The data show that the surgical approach for cardiac resynchronization therapy has durable long-term results.