The intravascular approach to cardiovascular surgery is extending the indications for the aging population. Because transaortic aortic valve replacement does not require opening the chest, the procedure benefits high-risk patients including the elderly. The introduction of open stenting to distal arch replacement and the hybrid approach to thoracoabdominal aneurysm repair significantly reduced surgical invasiveness. Well-established beating-heart surgery for coronary artery bypass grafting has become common in Japan. It is also contributing to reducing the risk to the aging population. Meticulous perioperative care for older patients, especially screening for vascular complications, is mandatory. Arterial diseases including those of the coronary, cerebrovascular, and peripheral arteries frequently occur in the elderly. The precise identification of risk factors and adequate perioperative care of complications are keys to the successful management of older patients who undergo cardiovascular surgery.