“…Despite these remarkable advances, over 40% of the very elderly manifest cardiovascular disease and , 3,4], now increasing from 7.7% to over 11% of total CABG procedures in the Society of Thoracic Surgeons (STS) database [5; David Shahian, personal communication]. Critical analysis of CABG surgery in octogenarians requires a clear understanding of the most current shortterm and long-term outcomes, the unique physiologic challenges encountered operating on the very elderly, the demonstrable impact on quality of life (QOL), the emerging role of viable alternatives, and the sobering realities of costs.…”