الفهرس 
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Abstract
Ethical Committee of Menoufia Faculty of Medicine approved this prospective study. It was conducted in Menoufia university hospital and National Heart Institute from 2016 to 2020 on 41 patients having MV and/or AV disease combined with significant CAD indicated for combined CABG and valve replacement surgery. Patients classified according to the type of diseased valve into Three groups: AV (n=20), MV (n=10) and DV (n=11) groups.
➢ This study aims to evaluate clinical outcome of combined CABG and valves replacement within 6 months regarding safety, efficacy, and feasibility. Comparative analysis of demographic, pre-operative, operative and post-operative data with follow up clinical outcome for 6 months was done.
➢ No statistical difference detected regarding mean age and sex between three groups.
➢ DM was the most frequent preoperative comorbidities in three groups without statistical significance. But, HTN and RHD were mostly frequent in AV and MV Groups respectively with significant difference.
➢ No significant difference detected regarding preoperative cardiac status, intraoperative complications, operative data including ACC, CPB times and post-operative intubation time.
➢ LAD was the most frequent target vessel for revascularization in all groups and SV was the most frequent conduit used. Also, BHV used more frequently without significantly different between the3 groups.
➢ ICU stay and Hospital stay were longest in DV group with significant difference
Summary
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➢ Within 1st month, pleural, pericardial effusion and AF were mostly frequent complications. While at 6th months AF persisted in 5 patients and hospital readmission for 2 patients for non-cardiac causes without significant differences between the 3 groups.
➢ Within 1st month, PPM insertion in 3 patients in DV group, who developed complete heart block post-operatively with statistically significant difference. It is well established that prolonged CPB and ACC times increase the likelihood of needing PPM postoperatively.
➢ Within the 1st month the overall mortality rate was 2 (4.9%) patients, one patient (10.0%) in MV from multi-organ failure with sepsis and one patient (9.1%) in DV Groups died from MI, and no mortality reported at 6 months of follow up without statistical significance between three groups.
➢ Follow up ECHO between three groups separately revealed no significant differences, but overall, ECHO data for 39 survivors revealed significant increase in mean postoperative LVEF and significant improvement of wall motion abnormality at 1st and 6th month.
➢ In addition, Echo showed significant decrease in mean post-operative LVEDD at 1st and 6th month while mean postoperative LVESD decreased without significant difference.
➢ NYHA grade improved progressively throughout follow-ups and the differences were statistically significant with symptomatic improvement at 1st and 6th month. Most of our patients in the last visit were grade I or II according to the NYHA classification.