Summary Although common sense still dictates caution when prescribing bypass surgery in elderly patients, the use of this procedure is increasing. With greater experience, outcomes from surgery in the elderly have significantly improved over time despite higher preoperative risk profiles. The elderly continue to have higher operative mortality rates and more complications and incur increased costs, however. If they survive surgery, many elderly patients undergoing bypass surgery achieve life expectancies similar to or greater than age-matched controls. Although more clinical data, including a randomized study, in the elderly are clearly indicated, in the meantime the increased risks for surgery in the elderly must be individually weighed against the benefits to be gained from symptom relief and improved quality of life.