The technical evolution of cardiac surgery in the last decades has been rewarded with long-term survival with few complications. A matching improvement in the quality of this survival as subjectively felt by the patient has now become the most important to assess the justification of surgery.

The 1990s have been characterized by a reappraisal of allocating expenditure for health care interventions. Coronary artery bypass in the elderly has emerged as an example of burgeoning expensive surgery whose appropriateness is under challenge.