As the waiting list for donor hearts increases, innovative ways to expand the donor pool are being utilized. For urgent status I and older age recipients (ages 60–70 years), we have been using donor hearts with normal left ventricular function but with pre-existing coronary artery disease and performing saphenous vein bypass grafts (SVG) at the time of transplantation. We now report our short term results. Between March 1992 and June 1994, 10 patients (5 urgent status I with mean age 50.4 years and 5 older age patients with mean age 65.4 years) underwent cardiac transplantation in our institution having either 1, 2 or 3 SVGs performed at the time of transplant surgery. The mean donor age was 54.2 years. Six of 10 patients have survived to 1 year with 3 early deaths and 1 late death due to infection (2 patients), rejection and early graft failure. Autopsies revealed all SVGs to be patent in all 4 patients. At the first year coronary angiogram, 9 of 10 SVGs (in 6 patients) were found to be patent without significant stenoses present. Cardiac function at 1 year after transplant was as follows: Average Cardiac Function at 1 year post OHT RA (mmHg) PA (mmHg) PCW (mmHg) CO (L/min) LVEF (%) SVG patients 4 ± 2 17 ± 6 9 ± 4 6.4 ± 1.6 60 ± 4 Conclusion Patients transplanted with bypassed donor hearts appear to have normal cardiac function and acceptable short term survival considering their preop high risk status. A majority of SVGs remain patent at 1 year with coronary ischemia not appearing to be responsible for early mortality.