Abstract: ObjectiveTo study the indications and safety in the surgery of CABG combined with valvular replacement for the patients with both CHD and rheumatic heart diseases(RHD) or valvular diseases.Methods In 12 cases of patients with combined coronary artery and valvular heart diseases CABG and valvular replacement surgery were performed from 2001 May to 2004 December in Xuanwu Hospital,CUMS.Moderate hypothermia myocardial protection was used in cardiopulmonary bypass.8 cases of 12 are males,4 cases are females,age ranging 52 to 78(mean 64.5).3 cases presented with RHD,preoperative angiography indicated coronary artery disease.9 cases presented with coronary artery disease(CAD) combined with valve disease.Angiography of 12 cases showed single vessel disease in 1 case,double vessel disease in 3 cases,and three vessel disease in 8 cases,associated with hypertension in 8,diabetes in 6,heart disfunction in 5,and atrial fibrillation in 7.Left ventriclar end diastolic diameter showed 45～87 mm [mean(56.7±77) mm],left ventriclar ejection fraction demonstrated 24%～67%(mean 50.3%±11.7%).Heart function(NYHA) showed grade Ⅰ in 1 cases,Ⅱ,Ⅲ,Ⅳ in 8,2,1 cases respectively.9 out of 12 underwent CABG+MVR(mitral valve replacement),CABG+AVR(aortic valve replacement) in 2,DVR(double valve replacement) in 1.Results All cases in this study recovered smoothly both peroperatively and postoperatively,no death was found after 3 months to 2 years follow up.Conclusion Coronary angiography is indicated for the patients presented with RHD aging above 50 regardless of the manifestation of pectoris angina or not.Valvar replacement is performed for the patients suffered from CAD combined moderate to severe MI or severe aortic valve calcification.For the cases with combined CAD and valve diseases,CABG plus valve replacement might result in the difficulty of procedures,however it might be beneficial for patients in terms of the prognosis and decreasing mortality in particular.

Key words: coronary artery disease, rheumatic heart disease, coronary artery bypass grafting, valve replacement