<p>Coronary artery disease (CAD) is one of the most frequent diseases in the western world with increasing prevalence. Approximately one third of CAD patients will eventually need coronary artery bypass surgery (CABG). CABG is defined as a&#xa0;high-risk procedure when factors are present that substantially increase the risk of perioperative complications. The majority of such risk factors are identified by validated scoring systems, e.g. the EuroSCORE or STS score. Some of these parameters, e.g., reduced left ventricular function or pulmonary hypertension, can be modified, e.g., by the use of certain substances or a mechanical support system to reduce the risk of perioperative complications. Other parameters, e.g. frailty, are less well-defined and difficult to influence. Graft quality, the extent of aortic calcification or the presence of additional valvular pathologies also influence the perioperative risk calculation. The expectations for the success of surgical revascularization are high. Especially in view of the increase in older patients with more complex CAD and more comorbidities, the preoperative risk evaluation must therefore be made in such detail that the risks associated with the intervention can be adequately anticipated and overcome. In addition to prognosis, the quality of life and expected time for recovery are increasingly becoming the focus of discussions in the heart team and with the patient. This article gives an overview of the perioperative identification and management of patients with a high risk of complications during surgical revascularization.</p>