<p>The transformation of surgical myocardial revascularization increasingly focusses on an individualized patient-centered bypass concept. In addition to the selection of bypass grafts this also includes the decision for coronary revascularization with or without the heart-lung machine, however, the opinions and “schools” on these issues differ considerably between the German cardiac surgery centers. This makes it all the more important to generate scientifically reliable data and evidence from randomized studies and large patient registries from healthcare research and meta-analyses. With respect to bypass grafts, larger randomized studies have demonstrated advantages in long-term survival and graft patency rates when multiple arterial bypass surgery was performed. It became evident that after using the left internal mammary artery (LIMA) to the anterior wall area, the radial artery should be used as a&#xa0;second arterial graft rather than the right internal mammary artery. In off-pump surgery some randomized studies have demonstrated benefits in terms of secondary endpoints, such as the incidence of atrial fibrillation, blood transfusion or length of hospital stay; however, with respect to the key endpoints of mortality and myocardial infarction, off‐pump procedures show less good results. Of particular importance is the observation from large registries that the life expectancy of patients who underwent bypass surgery equals or even exceeds the life expectancy of an age-matched control population.</p>