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During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients of advanced age and patients with increasingly complex coexisting conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass grafting (CABG) surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past but also more likely to have such health problems as hypertension and diabetes. Risk stratification may help to identify the ‘high-risk’ patient: forewarned is forearmed.

In high-risk cardiac surgery patients the surgical treatment options and perioperative care must be tailored to each patient in order to optimize the benefits and minimize the risk of detrimental effects. The perioperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications.