The indications and counter indications of coronary artery bypass surgery are a principle guideline, and the actual clinical practice should be analyzed according to the patient’s individual situation, combined with the patient’s physical condition, other tissues and organ functions, cardiac and vascular lesions, bypass vessel materials, and other counter conditions of the patient. The following are the surgical indications summarized in the guidelines and personal clinical practice for your reference: 1. ① Coronary artery bypass grafting is preferred for three-branch coronary artery lesions; ② bypass grafting is preferred for left main artery lesions; ③ single or double-branch coronary artery lesions, but the lesions are complex or diffuse and not suitable for medical intervention; ④ restenosis after stenting; ④ bypass grafting is preferred for patients with multi-branch coronary artery lesions with diabetes mellitus; ⑤ if there is a combined left ventricular wall tumor requiring surgical resection, the coronary artery lesion should be treated with bypass grafting at the same time and medical intervention should not be considered If there is intracardiac surgery such as valvuloplasty or replacement, or other intracardiac operations, coronary artery lesions should be treated by bypass at the same time, and medical intervention should not be considered; ⑦ If coronary artery fistula is combined with coronary artery fistula, if the fistula shunt is obvious and cannot be solved by interventional methods, surgical operation and coronary artery bypass should be chosen at the same time. 2.Surgical counter-indications (1) The coronary artery lesion is diffuse or slender, and there is no choice of the bypassed vessel. To make this conclusion requires rich experience in coronary surgery, especially for those with distal slenderness, we should consider the effect of insufficient coronary artery perfusion, and combine positive and negative perfusion; (2) no choice of bypass material vessels. In general, we have bilateral internal mammary arteries, bilateral radial arteries, bilateral saphenous veins to choose from, the above vessels are not available and there are also gastric omental arteries, bilateral small saphenous veins to choose from, and the chance of not being available at the same time is very rare. If none of the above vessels are available, or if the total number of bridges is not enough, more sequential anastomoses and Y-shaped anastomoses can be chosen. In addition, the application of the superior abdominal wall artery and the veins of the upper extremity can be considered. Theoretically, any artery of the forearm can be taken, but if the Allen test is positive, it is not available. It is rare to find patients with no vascular material suitable for bypass in general. Careful analysis and comprehensive consideration are needed before surgery in patients with poor vascular material, and more intraoperative preplanning is needed. (3) Poor general condition of the patient. Some patients with coronary artery disease have long disease duration, heavy vascular lesions, patients have been bedridden for a long time, and their general condition is poor, and they are unable to sit up and move to the ground. Such patients need good drug adjustment and appropriate physical exercise, after a period of restorative exercise before giving the patient a conclusion. (4) Severe functional impairment of other organs and organs. Post-stroke hemiplegia is not a contraindication to surgery, but in case of fresh stroke, it is advisable to wait for the stabilization of neurological symptoms, which should generally be more than one month, preferably more than three months, before coronary artery bypass surgery. Transient ischemic attack (TIA) generally has little effect and surgery can be scheduled after a few days. Coma and severe post-stroke sequelae are contraindications to surgery in the short term and can be observed for three to six months and then re-evaluated. Patients with renal failure and uremia should be discussed with nephrology. If the patient is stable on dialysis, bypass surgery can be done with one dialysis before surgery. If the patient has had a kidney transplant, renal function is stable and not a contraindication to surgery. Respiratory bypass At present, we mainly look at Po2 and Pco2 and whether the patient has respiratory symptoms. The presence of respiratory failure is an absolute contraindication to surgery. If the patient does not have respiratory symptoms, we generally require Po2 to be above 60 mmHg and Pco2 to be less than 45 mmHg. The limit of Po2 is set at 55 mmHg for my personal experience, and there is no uniform standard. If there is no history of occupational disease, Pco2 should not be greater than 45mmHg, which is a more sensitive indicator. Individual coal miners we have also done Pco2 to 55mmHg, but in short if Pco2 is increased need to be carefully considered, 50mmHg or more we generally do not consider surgery, if necessary, can be combined with pulmonary function test comprehensive consideration. There is no standard for the degree of liver impairment that contraindicates surgery, and it is usually necessary to consult with a hepatologist to discuss it together. (5) With other more serious diseases. For example, advanced malignant tumor, advanced AIDS, or various other diseases that have endangered the patient’s life.