Elderly and high-risk patients are increasingly being considered for myocardial revascularisation. Most trials comparing the various options for revascularisation exclude elderly and ‘high-risk’ patients. We have reviewed the options for myocardial revascularisation for elderly patients, and for patients with a number of common ‘high-risk’ co-morbidities – diabetes mellitus, renal insufficiency, poor left ventricular ejection fraction, peripheral vascular disease, left main coronary artery disease and chronic obstructive pulmonary disease – with a focus on coronary artery bypass grafting without the use of cardiopulmonary bypass and aortic manipulation.