In recent years, coronary artery bypass surgery is no longer an unfamiliar term used to treat coronary heart disease. Since coronary artery disease causes pain after activity, it also triggers the risk of developing myocardial infarction in patients. Therefore, it needs to be treated with the right intervention in a timely manner. Typically, total arterialization or bilateral internal mammary artery bypass grafts have better long-term results. Nevertheless, many patients still have some doubts about coronary artery bypass grafting surgery, and here are answers to some frequently asked questions. Question 1: What interventions are available for coronary artery disease? Since medication can only control and slow down the progression of the disease, in order to be able to contact the patient’s angina symptoms, improve the quality of life, and prevent myocardial infarction from occurring, the following two interventions can be taken. The first is coronary artery bypass grafting, also known as bypass surgery, in cardiac surgery, and the other is cardiac catheterization stenting in cardiology. They both aim at regaining the blood supply to the heart muscle, hence the intervention treatment is also called myocardial revascularization. Surgical bypass surgery involves taking a section of blood vessel from the patient and attaching it to the distal side of the aorta and stenotic coronary arteries so that the myocardium is immediately well perfused, regardless of the severity of the proximal lesion. Since the tissue used is autologous, there is no rejection and the long-term results are more certain. However, because this procedure requires an open chest, it is relatively traumatic. Internal medicine improves the blood supply to the heart muscle by placing a metal stent through a cardiac catheter to widen the narrowed area. The advantage of this method is that it is less traumatic for the patient, but the long-term effect is not as good as bypass surgery. Since the implantation of metal stents can cause significant endothelial proliferation, in recent years, researchers have developed drug-coated stents. The original metal stents are coated with cytotoxic drugs that can be used in tumor chemotherapy to inhibit the growth of autologous endothelial cells and prevent restenosis. This kind of stent is applied to the clinical time is short, lack of long-term effect data. [Question 2] Is bypass surgery better when it stops beating or when it doesn’t? Typically, there are several approaches to bypass surgery. One is to perform the anastomosis while the heart is in a state of arrest with the support of extracorporeal circulation. The second is a procedure in which the anastomosis is performed without the use of extracorporeal circulation, while the heart is kept beating and working, using a special fixator that secures the myocardium in the area to receive the anastomosis. The third is an in-between method, in which the heart is operated under extracorporeal circulation while the heart is still beating. In a way, each of these approaches has its own advantages. Surgery without extracorporeal circulation, with relatively low blood loss, is suitable for patients with good vascular conditions and not very large hearts. However, in some unstable patients, turning the heart can risk cardiac arrest, so this approach is less suitable for patients with deep vascular lesions or diffuse lesions. In patients with large, high-stress hearts, where non-corporeal surgery is generally difficult, non-stop bypass supported by extracorporeal circulation is safer. This is because bypass surgery performed in the off-beat state, supported by extracorporeal circulation, provides precise vascular anastomosis with good near- and long-term bypass vessel rates. In conclusion, patients should choose the most suitable treatment plan for themselves according to their condition and after consulting with specialized doctors. Question 3] What are the methods of minimally invasive bypass grafting? In recent years, with the advancement of technology, more and more surgeons are trying to minimize the trauma to the patient through various means. Endoscopic removal of the saphenous vein is a clinically well-established method. While the traditional method makes a long incision in the leg, endoscopic removal requires only one of three to four 1-1.5 cm long incisions. Coronary artery bypass grafting performed with thoracoscopic or robotic assistance uses a lateral thoracic incision, and with thoracoscopy, the main incision is 6-8 cm long, with several 1 cm holes. With robotic-assisted surgery, the incision is even smaller, about 4-6 cm; however, robotic-assisted bypass requires a lot of special equipment and stitches, and the procedure usually takes longer.