**6. Conclusion**

Complex CAD remains a challenge for cardiac surgeons; however, evolving techniques and strategies can be used to overcome this challenge. Although reoperative CABG is a high-risk procedure, proper preoperative assessment and surgical planning has yielded excellent results. Patients who are not candidates for CABG or percutaneous coronary interventions due to diffusely diseased vessels can be offered coronary endarterectomy. Calcified aorta encoun‐ tered during surgery can be managed by aortic replacement, endarterectomy, using no touch technique or off-pump CABG. TMR may be indicated for patients who have exhausted non surgical options. The outcomes in this complex coronary artery surgery are improving and the results have validated the safety, effectiveness and health outcomes. However, it is crucial to make good patient selection as well as intraoperative decision. Cardiac surgeons must familiarize themselves to these procedures as coronary artery disease patients will be more complex in the future.
