Objective: To summarize the surgical timing, surgical management and perioperative management experience of emergency coronary artery bypass grafting in patients with unsuccessful interventions after coronary interventions complicated by perforation, sandwich formation, occlusion and acute infarction combined with hemodynamic instability. Han Lin, Department of Thoracic Surgery, Shanghai Changhai Hospital, Shanghai, China: From January 2002 to August 2009, a total of 19 cases of emergency coronary artery bypass grafting after failed coronary interventions were performed in our hospital and 4 collaborating hospitals, including 15 cases in our hospital and 4 cases in outside hospitals, aged 47-63 years (59±4 years). There were 5 cases of coronary artery entrapment due to balloon dilation (3 cases in the right coronary artery, 1 case in the gyral branch, and 1 case in the anterior descending branch); 4 cases of coronary artery perforation (1 case in the right coronary artery trunk, 2 cases in the anterior descending branch, and 1 case in the posterior descending branch); 3 cases of acute occlusion (2 cases in the anterior descending branch, 1 case in the diagonal branch and the anterior descending branch); 7 cases of hemodynamic instability after failed intervention for acute infarction (4 cases of extensive anterior wall infarction, 4 cases of extensive anterior wall infarction combined with ventricular septal perforation (after interventional closure of ventricular defect) in 1 case, and mitral papillary muscle rupture in 2 cases), and the time between surgery and interventional treatment was 1.5h-42h, and IABP was placed preoperatively in 8 cases and pericardial drainage tube was placed preoperatively in 4 cases, all of which were patients with coronary artery perforation. Among the 5 cases of coronary artery entrapment formation, 3 cases were sutured to close the proximal end and perform coronary artery bypass grafting of the distal vessels and major branches, 2 cases were repaired by repairing the anastomosis and bridging with a bridge vein piece after cutting the lesion and repairing the entrapment; among the 4 cases of coronary artery perforation, 3 patients had their coronary arteries cut at the perforation site, and the coronary artery incision was enlarged along the stent and the stent was removed. In one case, the proximal part of the stent was cut out, the proximal end was sutured shut, and the distal end was bypass grafted with a bridging vein piece to the coronary artery and bridged at the same time; in three cases of acute occlusion, two patients underwent target-vessel coronary artery bypass grafting, and in one case, because the stent was placed far away, the coronary artery was cut on the surface of the stent and bypass grafting was performed with a bridging vein piece. In one case, because the stent was placed far away, the coronary artery was cut on the surface of the stent, part of the stent was cut out, and a bridge vessel with a vein piece was used for bypass grafting; CABG was performed in 7 cases of acute infarction, 2 cases in 2 vessels, 4 cases in 3 vessels, 1 case in 4 vessels, 1 case of MVR and 1 case of MVP were performed at the same time. Results: There were 5 cases of surgical death in the whole group, and the surgical mortality rate was 26%, including 2 cases of emergency surgical death due to post-interventional complications of perforation, entrapment formation and occlusion, and the mortality rate was 16%, all of them were patients with coronary artery entrapment formation, and the myocardial contraction in the area involved in the diseased vessels was weak after surgery, and all of them died due to low cardiac output, the rest of the patients recovered and were discharged from the hospital without obvious angina pectoris and chest tightness after activity, and after discharge The rest of the patients recovered and were discharged without significant angina pectoris and chest tightness after activity, and the cardiac function returned to normal on repeat echocardiography after discharge. Among the 7 cases with hemodynamic instability after failed intervention for acute infarction, 3 cases died, with a mortality rate of 43%, all of which were due to postoperative cardiac contraction weakness, 1 case died of bleeding from ECOM support after the operation, and 2 cases died of IABP support after the operation due to multiple organ failure such as renal function and pulmonary function after 4 and 7 days, respectively, and 5 patients were discharged from the hospital with a six-month postoperative review of cardiac echocardiographic function recovered well. Conclusion: Emergency CABG after coronary intervention refers to the urgent need for salvage by surgery after PCI in order to avoid unnecessary serious complications and death, which has high surgical risk, high surgical technique requirements, difficult perioperative management, and must be implemented as early as possible due to interventional complications such as entrapment, perforation and occlusion, which can achieve satisfactory clinical results as long as they are properly handled, while acute infarction intervention The mortality rate of early surgical treatment in patients with failed hemodynamic blood instability is high, the choice of surgical timing is still controversial, and further improvement in perioperative management is needed.