It is well known that coronary heart disease is currently the most common cause of human death. In our country, the number of patients with coronary heart disease will continue to increase due to the improvement of economic conditions, quality of life and lack of health education efforts. Because of the less invasive, more convenient, patient-friendly and other reasons besides drug treatment, more and more patients are receiving interventional treatment and stents. As interventional techniques and conditions continue to improve, the number of patients undergoing surgery for coronary artery disease is decreasing significantly, and the patients undergoing surgery are becoming sicker and more demanding for cardiac surgeons. Whether to operate under extracorporeal circulation (on-pump) or off-pump was once the focus of debate on the surgical approach to treating coronary artery disease. In fact, many clinical studies on this subject have some limitations. At the 2009 European Annual Meeting of Cardiac Surgery, it was reported that the use of off-pump in developed countries was 25%. Overall, patients operated under non-extracorporeal circulation are less severely affected than those operated under extracorporeal circulation. The special surgical instruments required for surgery under non-extracorporeal circulation, such as stabilizers, and the extracorporeal circulation itself, are an adjunct and support for bypass surgery. Non-extracorporeal circulation surgery can save patients from the danger and damage of extracorporeal circulation, short operation time, less blood used for surgery, and faster postoperative recovery, which is worth studying and promoting, but care should be taken to ensure the quality of the anastomosis and adequate reconstruction of blood flow. With the improvement of anesthesia and extracorporeal circulation technology, bypass surgery under routine extracorporeal circulation is becoming safer and safer. For patients with other intracardiac pathologies or poor vascular conditions and critical conditions, bypass surgery under extracorporeal circulation is mandatory. Regardless of whether extracorporeal circulation is used or not, during the procedure, care must be taken to avoid damage to the bridge vessels, to continuously improve the anastomosis technique and the quality of the bridge, and to adequately recanalize the myocardial ischemia to achieve significant improvement. This is not only related to the successful recovery of the patient after surgery, but also to the long-term outcome of the patient. The long-term outcome of coronary artery bypass grafting is not only related to the procedure and the patient itself, but also determined by the materials used. The long-term patency of arterial vessels such as the internal mammary artery and radial artery is superior to that of the saphenous vein, as has been demonstrated over many years of practice. The use of “No Touch” techniques and minimally invasive techniques, such as endoscopic harvesting, should be used to obtain the saphenous vein or arterial vessels to reduce trauma to the patient and to protect these replacement vessels, which is important for the long-term outcome of the bypass patient. Systemic arterialization is also valued by some physicians, but is not as convenient as using the saphenous vein, so it accounts for about 18% of systemic arterialization in most centers around the world. In patients with mild to moderate mitral valve insufficiency in combination with coronary artery disease, it can be left alone if the patient’s left ventricle is not significantly enlarged. In patients with moderate mitral valve insufficiency, mitral valvuloplasty or valve replacement should be actively managed, depending on the lesion, with mitral valvuloplasty being the first choice. As in developed countries, the number of patients requiring valve replacement or valvuloplasty for degenerative disease will increase in China. Many patients with other valve diseases also require coronary artery bypass grafting at the same time. This may increase the risk of the procedure due to its complexity and longer operative time. Intraoperative attention should be paid to good myocardial protection, resolving the relationship between improving myocardial blood supply and operation time, resolving valve surgery techniques and heart cavity venting to prevent embolism, and avoiding complications such as brain and nerve from various causes. The general surgical procedure is to remove the valve first, then anastomose the distal end of the artery, then perform valve replacement, close each heart incision, and then anastomose the proximal end. If each detail of the operation is well attended to, the success rate of the operation will be significantly improved. The current surgical success rate should be above 97%. The most timely and effective treatment for the occurrence of acute heart attack in coronary heart disease is interventional and pharmacological treatment, so the number of emergency surgical procedures will also be reduced. If myocardial necrosis occurs, resulting in ventricular septal perforation, papillary muscle rupture, significant mitral valve insufficiency, and to prevent hemorrhage from cardiac rupture, aggressive surgical treatment should be performed. Preoperative preparation should be adequate and patients should be carefully evaluated for surgical risk and efficacy. We should strive for a period of preoperative adjustment to reduce the risk of emergency surgery and operate after the patient’s condition has stabilized, but we should not allow the patient to develop more serious secondary pathologies, such as progressive cardiac insufficiency and acute pulmonary edema, and lose the opportunity to operate. The key is to closely observe and grasp the timing of surgery during this process and make the right decision in time. In general, surgery can be considered after 2 weeks of myocardial infarction. The myocardium of patients with acute myocardial infarction is relatively weak, and the ventricular septum is prone to residual shunts. However, if a large number of intracardiac left-to-right shunts reduce the burden on the heart, the patient’s life can be saved even with residual shunts. Cardiac incisional hemostasis is often difficult and should be adequately prepared. Coronary artery disease combined with ventricular wall tumor formation is also common. In case of true ventricular wall tumors, the diseased myocardium should be removed as much as possible and bypass surgery should be performed at the same time. For ventricular tumors with a neck diameter <2 cm, linear resection and sandwich suturing are the most common surgical approaches, and most patients can achieve good results. For ventricular wall tumors with neck diameters >2 cm, the normal left ventricular geometry and function can be maintained, and a patch-forming approach is more effective than linear resection. Outside of these two management approaches, there have been no new advances in the last decade or so. Pseudoventricular wall tumors are rare and are formed by small myocardial perforations that bleed and are then encapsulated by fibrous tissue and should be operated on to prevent bleeding and improve left heart function. Surgery for functional ventricular wall tumors should be performed with caution. Functional ventricular wall tumors arise from the coexistence of surviving myocardium and infarcted fibrotic myocardium after a large infarction, and their distribution and number, as well as their duration and functional status, determine the degree of ventricular expansion and function. If there is no surviving myocardium, even if bypass is possible, it will not help myocardial ischemia, and reluctant surgery may bring more danger. However, if there is more surviving myocardium and the coronary artery lesion is severe, surgery is not only safe, but also can achieve significant results. We have treated several patients who were prepared for heart transplantation by outside hospitals with satisfactory results by conventional bypass surgery. In patients over 70 years of age and with combined peripheral vascular disease such as carotid and renal artery stenosis, poor vascular conditions, women and old myocardial infarction are high risk factors for surgery. However, if patients can be adequately prepared before surgery, master the indications and timing of surgery, adequately restore myocardial blood supply during surgery, and strengthen the perioperative management, the same surgical outcome as other patients can be obtained. For patients who cannot undergo interventional treatment or tolerate extracorporeal circulation, it is not necessary to adequately vascularize and terminate the operation after resolving the stenosis of important vessels. This should not be done for other patients. The angle and size of each anastomosis, the position and length of the bridge, the saphenous vein and the radial artery should be fully considered in all bypass procedures, and special attention should be paid to how to suture and how to avoid damage to the saphenous vein and internal mammary artery to avoid bleeding or stenosis. Hybrid technique (Hybrid) may be less invasive and faster recovery for patients with coronary artery disease. However, anticoagulation is required after stent placement, and bypass surgery requires hemostasis, which may increase bleeding in patients after anticoagulation. There is a consensus among cardiac surgeons that the chance of restenosis after stent placement is significantly higher than that of bypass. If patients need reoperation, hybridization is not as safe as simple stent placement, because if the bypassed anterior descending branch is damaged during reoperation, the patient will suffer irreparable damage (only one left internal mammary artery) and the risk of cardiac arrest. Moreover, if the number of patients is small, the hospital needs to invest more to establish a hybrid operating room, which will cause a waste of resources. A truly minimally invasive technique for coronary artery disease relies on advanced surgical instruments and equipment. Minimally invasive robotic non-extracorporeal circulation coronary artery bypass grafting has made a good start in China, and more progress may continue to be made. The main complications after bypass surgery are still perioperative infarction, low cardiac output and arrhythmias. The most common of these arrhythmias is atrial fibrillation, most of which can be controlled with cortisone. Neurological complications, such as cerebral infarction, require blood pressure, glucose and lipid control for prevention. In addition to the progression of the coronary artery lesion, the most important factors for long-term outcome are the quality of the bridge and blood flow, and the underlying lesion.