Background: N Chronic total occlusion (CTO) of a major epicardial coronary artery represents advanced coronary artery disease and is commonly associated with persistent ischemia and impaired quality of life. While coronary artery bypass grafting (CABG) is an established revascularization strategy, data on long-term symptom-free survival and patient-reported outcomes in CTO remain limited. Objectives: To estimate symptom-free survival among CTO patients followed for at least 24 months after elective CABG and to assess postoperative quality of life. Methods: This retrospective cohort study included adults who underwent elective CABG for documented CTO at a tertiary cardiac center between January 2013 and December 2020, with a minimum follow-up of 24 months. Clinical characteristics, comorbidities, operative variables, and risk scores, including EuroSCORE II and SYNTAX II were retrieved from institutional records. Symptom-free survival was assessed through follow-up documentation and structured telephonic interviews. Quality of life was evaluated using the Seattle Angina Questionnaire and Duke Activity Status Index (DASI). Kaplan–Meier analysis and appropriate statistical tests were applied, with p < 0.05 considered significant. Results: A total of 177 patients with 222 CTO lesions were analyzed, most with single-vessel involvement. At three years, nearly half remained free from recurrent angina. Chronic obstructive pulmonary disease was significantly associated with reduced symptom-free survival (p < 0.05), whereas diabetes, hypertension, left ventricular dysfunction, and preoperative risk scores were not. DASI scores were significantly influenced by diabetes and hypertension and showed an inverse correlation with predicted mortality scores. Conclusion: Elective CABG in CTO patients provides meaningful mid-term symptom-free survival and satisfactory quality-of-life outcomes. Pulmonary comorbidity negatively affects postoperative symptom relief, while traditional cardiovascular risk factors show limited impact on survival duration. These findings support surgical revascularization in carefully selected patients with individualized risk assessment.