The goal of providing patent grafts distal to important coronary stenoses remains unchanged. Results of bypass grafting show the influence of refined technique, improved technology, and the longer followup now available. Coronary artery bypass is now routinely performed with low morbidity and mortality. Late attrition of saphenous vein grafts with concomitant deterioration of patients' clinical status has been increasingly recognized. The internal mammary graft, with its superior patency and impact on length and quality of survival, is gaining wider acceptance. Increased use of the mammary artery graft and extension of its use with bilateral and sequential grafting patterns are an important trend in the current practice of coronary surgery.