Coronary artery bypass grafting is a straightforward solution to the problem of myocardial ischemia secondary to coronary artery disease. More recently, the complexities of complications following myocardial infarction have been elucidated with respect to various aspects. Disastrous sequelae, such as rupture of the ventricular septum, the left ventricular wall and the papillary muscle, impose many intricacies on the inevitable surgical treatment; this form of cardiac surgery is still a tour de force. Life-threatening ventricular tachycardias due to transmural myocardial infarction and/or left ventricular aneurysm remain a surgical challenge. An attempt is made to delineate the current state of surgery for acute and chronic complications of myocardial infarction.