A 77-year-old man had a heart attack in February of this year. At that time, the echocardiogram showed an LVEDD of 6.1 cm, LVEF of less than 20%, severe regurgitation of the mitral and tricuspid valves, moderate regurgitation of the aortic valve, and ventricular wall aneurysm formation. Coronary angiography showed three lesions, with near occlusion of the anterior descending and diagonal branches. LVEDD was 5.6 cm, LVEF 32%, severe regurgitation of mitral and tricuspid valves, mild to moderate regurgitation of aortic valve, ventricular wall aneurysm was not obvious, but left ventricular and apical motion was poor. The heart was enlarged, with poor left ventricular and apical motion. Myocardial edema remained incomplete and brittle. Systemic heparinization and establishment of extracorporeal circulation. Transferred with poor reverse perfusion. Exploration revealed thin coronary sinus with tearing. The ascending aorta was immediately opened for fractional perfusion and stopped satisfactorily. At the same time, the aortic valve was explored for no regurgitation. The coronary sinus was carefully mended with 5/0 Prolene sutures with spacers. The ascending aortic incision was closed. The interatrial septum and left atrial apex were opened and the anterior mitral valve was seen to be prolapsed significantly and clipped, preserving the posterior valve. After measurement, a 27-gauge prosthetic bioprosthetic valve was sutured to the annulus. A tricuspid De Vega molding was performed after closing the left atrium. The water injection test was satisfactory. Open block was performed with aortic root pin insertion for suction and the heart was automatically resuscitated. The right atrial incision is closed and the lateral wall of the ascending aorta is perforated for proximal anastomosis. When the post-parallel adequate shutdown, caviar neutralization, and preparation for withdrawal of extracorporeal circulation, the amount of IABP-assisted vasoactive drugs was still very high, the ECG was unstable, and the blood pressure also fluctuated drastically. A thrombus was found in the anterior descending vein bridge. It was considered to be due to poor vascular condition and poor flow in the anterior descending branch. Immediately, heparinization, transfer, and blocking were repeated. The anastomosis was re-explored 1 cm distal to the original anastomosis and a distal anastomosis was performed. A Y-shaped anastomosis was performed proximally to the sequential bridge. Re-venting, open block, and automatic rebeating. Still assisted with IABP, moderate vasoactive drugs and pacemaker. ECG and circulation were stable. Flow reduction shutdown was smooth, extracorporeal circulation was withdrawn, and fisetin was neutralized. The chest was closed with careful hemostasis and returned to the CSCU. The night after surgery: PAWP 13, CO 2.16, CI 1.3, SVRI 4547, PVRI 983 The day after surgery: PAWP 17, CO 1.57, CI 1.95, SVRI 6057, PVRI 761 Two days after surgery: PAWP 28, CO 2.79, CI 1.68, SVRI 3854, PVRI 523 Three days postoperatively: PAWP 18, CO 3.54, CI 2.13, SVRI 2700, PVRI 675 Five days postoperatively: PAWP 14, CO 3.48, CI 2.1, SVRI 2746, PVRI 496 Ventricular tachycardia was present early in the postoperative period and was managed symptomatically. The tracheal intubation was removed on four days, IABP was withdrawn on five days, and the patient was transferred out of the CSCU on seven days. Experience: 1. The blow to the myocardium and cardiac function of the infarction is tremendous, and although most of the edema subsided three months after the infarction and the inflammatory mediators released by the stress response basically subsided, the myocardial mass could still be seen to be brittle, making exploration and surgical operation difficult; 2. In recent years, the vascular conditions, cardiac function and general status of the patient are far not as good as a few years ago, and the complications of heart attack are increasing, which can be detailed in the previous blog post; 3. “There is no hate without a reason in the world, and there is no love without a reason”, and there is no circulation that is difficult to maintain without a reason. The judgment of surgical results at this point requires a certain amount of clinical experience and the ability to improvise. Most cases may require revascularization of a vessel that was not originally planned to be bypassed, but sometimes it is the bridge vessel that has poor flow for various reasons and can be reanastomosed again at its distal end, but this will increase the time of the procedure and extracorporeal circulation. Especially for patients with poor cardiac function, there are many novices who have delayed the disease due to inexperience, doubt or difficulty in determination; 4. For this patient, severe mitral regurgitation is a clear complication of infarction, and it is difficult to be reversed even with recanalization. To decisively perform valve replacement surgery; 5. For whether this type of critically ill patients should be treated with active surgery, my personal view is that: the complications of infarction cannot be completed with interventional therapy at the same time at present, and if not actively operated, heart failure will be aggravated and life-threatening in the short term due to the complications of infarction. After the surgical procedure is completed concurrently with recanalization and proper treatment of valve regurgitation, there will be an essential improvement in cardiac function, and the long-term prognosis and quality of life will be guaranteed.