Background: Cardiac surgery in the elderly is performed with increasing frequency. Besides low mortality, an evident gain in quality of life is the most important aim of therapy. To investigate the medium-term outcome of cardiac surgery, we evaluated patients over 75 years of age who were operated on within a 1.5-year period. Methods: Between 01/98 and 06/99. 124 patients (76 male, 48 female) with a median age of 76 (range 75–86) years were operated on. 84 % had isolated coronary or valve procedures and 16 % had combined procedures. Pre- and postoperative New York Heart Association (NYHA) classification, follow-up period, perioperative mortality, and subjective satisfaction were recorded. Results: Total perioperative mortality was 6.4 %. After a median follow-up time of 16 (range 6–24) months, patient satisfaction with the operative results was excellent in 73 %, good in 26 %, and low (unsatisfied) in 1 %. The NYHA classification is shown in the table. Conclusions: Cardiac surgery in the elderly can be performed with an acceptable morbidity and mortality. The fact that 99.1 % of the patients are satisfied with their operation and the dramatic improvement in functional status (96.5 % NYHA I and II) justify cardiac surgery in this age.