The number of coronary artery bypass grafting (CABG) procedures is rapidly increasing, and elderly patients present a high incidence of secondary CABG within 20 years after the initial CABG. The high patency rate of the saphenous vein bridge and the left internal mammary artery bridge used for the initial procedure prolongs the time to secondary bypass. The surgery was performed under identical conditions with the same surgical team and uniform surgical technique, and the surgical risk was evaluated based on the patient’s preoperative records, catheterization records, echocardiography, angiographic fluoroscopy, and computerized graphic scanning techniques. Local neurological deficits for more than 24 hours were used as the basis for the diagnosis of cerebrovascular accident (CVA). Tracheal intubation for more than 48 hours or tracheotomy was used as a diagnosis of respiratory failure. Positive wound culture for sternal instability as a diagnosis of deep sternal infection (mediastinal infection) requiring secondary surgical debridement. Patients with low cardiac output syndrome requiring large amounts of catecholamines to stabilize the circulation and severe postoperative arrhythmias are used as indications requiring external balloon counterpulsation (IABP) adjunctive therapy. In these patients, the progression of coronary artery lesions after initial coronary surgery due to surgical technique or poor control of risk factors related to coronary atherosclerosis leads to new lesions in otherwise normal coronary arteries or stenosis of venous bridges, resulting in myocardial ischemia. Severe cases require re-surgical treatment. Vascular stenosis causes various types of angina pectoris, and conservative medical treatment is ineffective, affecting work and life. Bypass grafting with venous material on the left anterior descending branch, which causes large myocardial ischemia due to stenosis, with coronary artery target vessels available for bypass grafting, is an absolute indication for secondary coronary artery bypass grafting bypass surgery; a new serious lesion in a larger branch of the coronary artery, which may lead to large myocardial ischemia, should also be an indication for secondary coronary artery bypass grafting bypass surgery. Secondary surgery has many surgical technical difficulties for the initial surgery, such as surgical incision access, separation of cardiac adhesions, myocardial protection methods, extracorporeal circulation transfer methods, and protection of the patient’s vascular bridge. For this reason, there are differences in the results of the second surgery and the initial surgery. Especially for secondary patients with cardiac insufficiency, the operator needs to carefully study their surgical indications and decide carefully to perform coronary artery bypass surgery again. The transthoracic median incision approach is the classic approach for secondary CABG; however, there are some risks in dissecting the adhesions to separate the tissues, such as damaging the myocardial tissue, damaging the ascending aorta, and damaging the patent vascular bridge. The median incisional approach to CABG requires dissection to separate the gap between the left ventricle and the pericardium in order to reveal the obtuse marginal branches. Moreover, in the case of free venous bridge vessels, dissection of the ascending aorta is required to allow proximal anastomosis. Currently, surgical procedures for secondary CABG performed under non-extracorporeal circulation are being used with some success. Secondary surgery performed under non-extracorporeal circulation has the advantage of reduced anatomical separation area and less bleeding. Under non-extracorporeal circulation, tissue adhesions do not require satisfactory anatomical separation to perform coronary artery anastomosis in a stable state. We simply need to separate the tissue adhesions around the coronary lesion, reducing surgical injury, bleeding, and operative time. In the event of blockage of the initial bypass bridge under non-extracorporeal circulation, the target coronary artery can be easily identified using palpation pulses, allowing for accurate secondary bypass surgery. Numerous studies have demonstrated that incomplete revascularization affects intermediate and long-term follow-up outcomes. Patients with incomplete revascularization show a high incidence of cardiogenic death, acute myocardial infarction, and cardiac-related events [14, 15]. CABG does not affect the early clinical outcome of surgical procedures even though the pre-surgical clinical indicators are similar. We believe that incomplete recanalization is the pathological basis for less than optimal intermediate and long-term clinical outcomes. Secondary surgery differs from initial surgery. In general, secondary patients are older, have cardiac insufficiency, and are associated with more comorbidities. Due to the increase in acute secondary CABG procedures, non-extracorporeal circulation is considered to be of greater use for reducing surgical risk and rapidly isolating target coronary vessels. Non-extracorporeal circulation is divided into a median incisional approach and a left lateral thoracic approach, which can be chosen first for obstruction of the left gyral branch, or for bridge obstruction or stenosis with anastomosis of the left obtuse marginal branch. Moreover, patients with greater risk of median incisional approach can choose bypass surgery via left lateral thoracic incisional approach; however, for patients with stenotic lesions through having right coronary artery, median incisional approach must be chosen. At the same time, for secondary bypass patients with poor vascular conditions, extracorporeal circulation is a more appropriate approach in order to achieve complete recanalization, to reduce cardiac death, acute myocardial infarction, and cardiac-related events, and to improve the mid- and long-term clinical outcomes of the surgical procedure. Both extracorporeal and non-extracorporeal circulation are beneficial for secondary CABG surgery. There is no need to hold a bias as to the specific method to be used, but rather the method should be chosen on a patient-specific basis, and we should not focus on early clinical success outcomes at the expense of intermediate and long-term follow-up outcomes. Regardless of extracorporeal or non-extracorporeal circulation, complete revascularization without damage to the heart is the goal of the secondary procedure, achieving the same surgical outcome as the initial procedure.