We have reviewed a variety of techniques that have recently been used to improve the results of reoperation coronary bypass valve re-replacement and redo thoracic aortic surgery. The basic tenets of management in these high-risk areas are: (1) innovative use of cardiopulmonary bypass techniques to improve patient safety, including deep hypothermic arrest, (2) use of retrograde as well as antegrade infusion of cardioplegic solutions, (3) meticulous operative technique, (4) prevention of left ventricle distension, (5) TEE monitoring of intracardiac air, and (6) careful post-bypass hemodynamic monitoring. Reoperative CABG specifically requires avoiding injury to previously placed open conduits or atherosclerotic conduits, an increasingly recognized risk factor in these patients. Though direct myocardial cardioplegic protective techniques are very important for reducing operative risk, the importance of the total operative plan is critical for maximizing patient safety and ensuring improved long-term survival.