The subgroup of candidates age 75 and older for coronary artery bypass grafting (CABG) is increasing. Changing demographics have also influenced current practice. Between January 1985 and December 1989, 1498 patients underwent CABG; 109 (7.3%) were 75 or older (mean 77.3, range 75-87). This increased from 4.0% in 1985 to 12.2% in 1989. Mortality was 9.2% (elective cases 7.6%, emergent 50%), early mortality (0-10 days) 3.7%, and late deaths (11-90 days) 5.5%. Early deaths were attributable to cardiac failure and late mortality resulted from noncardiac organ failure. Actuarial probability of survival was 86% at 33 months (range 11-68). Mortality was highest in concomitant valve replacement (18.8%), NYHC IV (13.0%), postoperative bleeding (11.8%), and emergent priority (50%). Average cost for hospitalization per patient was $27,183; average length of stay in the hospital was 21.3 days. Changing trends have had a positive impact on improved long-term survival and quality of life, justifying continued elective cardiac surgery in selected patients.