Born in Chelyabinsk, USSR, Makarov first gained prominence by starring for his country when they won gold at the 1977 and 1978 World Junior Championships. Over the next several years he helped the USSR defeat the NHL all-stars in the 1979 Challenge Cup and humiliate the host nation to win the 1981 Canada Cup. The skilled winger also participated in 11 World Championships, the 1984 and 1987 Canada Cups, three Olympic tournaments, four NHL tours by the Red Army and Wings and the 1987 Rendez-vous series against the NHL all-stars. During this time he was often teamed with Vladimir Krutov and Igor Larionov on the feared "KLM" line, arguably the world's best unit. Makarov himself won the Izvestia Trophy nine times as the top scorer in the Soviet league.

Originally drafted 241st overall by the Calgary Flames in 1983, Makarov was one of the first Soviet stars to join the NHL in 1989-90. Oddly enough his first duty with his new club took place in USSR during the Friendship Tour which saw the Flames play several Soviet clubs as part of their exhibition season. When the NHL season began, the veteran sniper had little difficulty adjusting. He recorded 86 points and was presented the Calder Trophy.

Makarov continued to produce points on the Flames for three more years then joined the Hartford Whalers in a June trade. A few days later he was sent to the San Jose Sharks where he was reunited with Larionov to start the 1993-94 season. The two veterans teamed with Johan Garpenlov on the tricky "OV" line and helped the Sharks come within one game of the semifinals. Makarov and the Sharks slipped somewhat in 1994-95 after the lockout was resolved. He sat out the 1995-96 season then played four games for the Dallas Stars the next year after signing as a free agent. Before the end of the 1996-97 season he joined the Swiss club Fribourg Gotteron.