We analyzed the changing use of coronary artery bypass grafting in our institution during the years from 1985 to 1992. All clinical parameters indicating an increased perioperative risk for the surgical intervention increased during the study period (increased percentage of old patients, females, patients with severe coronary artery disease (high modified Gensini-index or triple-vessel disease), and left main stenoses). During a 2-year follow-up there was a constant proportion of patients with a good postoperative clinical result; perioperative mortality as well as global and cardiac 2-year mortality showed no significant changes. Despite an increased proportion of patients with higher perioperative risk the acute and long-term results of coronary artery bypass surgery in our study were quite satisfactory. This must be attributed to improvements in operative techniques, improved personal skills of the surgeons, and improvements in perioperative treatment and critical care.