The advent of cardiopulmonary bypass in the early 1960s allowed surgeons to safely perform complex reconstructions on the heart. Since then, the field of cardiac surgery has progressed to where surgical myocardial revascularization, or coronary artery bypass grafting (CABG), has become the most exhaustively studied operation in the history of surgery, and it has achieved widespread use because its benefits have been so thoroughly documented. The paradoxical fact is that more elderly and debilitated patients benefit the most from cardiac surgery compared with medical therapy, yet they sustain greater risk of morbidity and mortality after cardiac surgery. Most of the recent innovations and refinements in the treatment of coronary artery disease aim toward reduction of trauma without deviating much from the safety and efficacy of the conventional procedures. As a consequence, a greater number of high-risk elderly patients have become candidates for coronary artery bypass grafting (CABG). All of the amendments are caused by changing clinical scenarios brought on by an increased number of aging patients, a greater number of patients requiring re-operations, cost containment, increased discernment about outcome assessment, and also the dominance of coronary bypass being threatened by the success of interventional cardiology.