background and objectives: elderly patients have their own physiologic characteristics, and sometimes may have organic deficits or severe diseases, which by themselves may complicate the postoperative period. this article is aimed at reviewing post-cardiac surgery procedures in the elderly, describing their most frequent problems. contents: elderly patients intraoperative approaches should be decided taking into account lower postoperative morbidity. at icu arrival, the same criteria for other adult patients of cardiac surgeries should be adopted to maintain service standardization and routine, thus preventing mistakes. establishing an intensive care plan for the post-cardiac surgery period may result in optimal use of resources, effective attention and decreased time of care. subsidiary exams should also follow the standards of the service, unless any problem be identified. neurological, pulmonary and circulatory complications, renal failure, infections and hypothyroidism outlined in this article are frequent and unique in the elderly, and should be fully understood by the icu physician. conclusions: complications outlined in this article are those of greatest concern for the icu physician when there are elderly patients in the post-cardiac surgery period. these patients need special care, even when surgery is perfectly normal, because there is major surgical stress and the elderly have decreased functional reserves.