Coronary atherosclerotic heart disease and heart valve disease are both common heart diseases in China. Currently, there are about 200,000 valve surgeries each year in China, accounting for the first place in adult cardiac surgery. Although the incidence of rheumatic heart valve disease has decreased significantly in recent years, the development of population aging has caused degenerative heart valve disease in the elderly to seriously affect people’s health and quality of life, and with the aging of the population, changes in nutritional structure and people’s awareness of the disease, the number of patients with heart valve disease combined with coronary atherosclerotic heart disease has increased year by year. Especially for men over 50 years of age and women over 55 years of age with valvular disease, the risk of combined coronary heart disease is higher, therefore, they all need to routinely undergo coronary angiography before undergoing cardiac surgery. However, performing coronary artery bypass grafting and heart valve surgery at the same time involves many steps, complex operations, and long operative times, and the early operative morbidity and mortality rates remain high. The pathophysiological interactions between valve disease and coronary artery disease are complex. When heart valve disease is combined with coronary artery disease, it often aggravates or masks each other’s symptoms, and even if some patients are asymptomatic, surgical management of coronary artery disease is often required to reverse the combined pathophysiological changes of both diseases, maintain the stability of the perioperative pathophysiology, and improve the long-term postoperative outcome. The literature reports that patients who undergo valve replacement and bypass grafting at the same time account for approximately 10% to 15% of the bypass surgery population, and this proportion is increasing each year. Aortic valve lesions are often associated with ischemic heart disease, and the 3-year postoperative survival rate for patients with concurrent aortic valve disease with coronary artery lesions is 85%; whereas the 3-year postoperative survival rate for patients with aortic valve replacement alone is 60%, and 15% of patients will have myocardial infarction and bypass surgery. In 1958, Dr. C. Walton Lillehei was the first to perform prosthetic aortic valve replacement surgery under extracorporeal circulation. For many years, surgical valve replacement has been the mainstay of treatment for symptomatic valve disease, but in patients of advanced age and with coexisting multisystem disease and poor cardiac function that cannot tolerate conventional valve replacement, the surgical procedure is highly invasive, requires extracorporeal circulation, and carries high surgical risks, and many patients cannot be effectively treated as a result. Especially for patients with combined coronary artery disease, valve replacement with bypass surgery is risky due to the problems of long operative time and poor myocardial protection such as poor perfusion of stopping fluid. The surgical indications for traditional valve surgery with coronary artery bypass grafting: 1. Preoperative coronary angiography suggests that the coronary stenosis is mild (less than 40% to 50%) or that the stenosis exists in small and unimportant coronary branches such as diagonal and obtuse marginal branches. Coronary artery problems may not be addressed during valve surgery. To reduce unnecessary surgical steps and shorten the operation time; 2, coronary artery disease combined with mild to moderate ischemic mitral valve insufficiency can be done only with coronary artery bypass surgery. When the heart blood supply improves, mitral regurgitation is reduced or disappears; 3, moderate to severe mitral insufficiency such as combined pulmonary edema or heart failure, rheumatic mitral aortic valve lesions, etc. should be treated with surgery at the same time; 4, the patient’s general condition is poor, malnutrition is serious. Cardiac function grade III or below, EF less than 35%, multi-branch, extensive, diffuse coronary artery lesions. The patient should be treated conservatively with internal medicine. With the development of interventional cardiology, valve problems such as ischemic mitral valve insufficiency can be treated with interventional revascularization to obtain excellent results. Coronary lesions such as mild coronary artery stenosis (less than 40% to 50%) or stenosis in small and unimportant coronary branches such as diagonal and obtuse marginal branches can also be resolved by PCI techniques before surgery, so-called hybridization, but for complex patients with multiple lesions including anterior descending branches and severe left main stem lesions, surgery is still the best option. In addition, the development of minimally invasive surgical techniques has led to a significant reduction in the risk of valve-plus-bypass surgery. A controlled study by a group of cardiac surgeons in New York, USA, published in the June issue of the European Journal of Cardiology, showed that minimally invasive small-incision valve replacement with bypass surgery has a definite therapeutic effect and low surgical risk, with no perioperative death or reoperation in their patients, and the hospital stay and complication rates are much lower than those of traditional median open-heart surgery, which is more suitable for patients with poor cardiac function. patients with valve disease combined with coronary artery disease. The new interventional heart valve placement is expected to be an effective alternative treatment for high-risk patients who cannot tolerate cardiac surgery because of contraindications such as age, frailty, heavy lesions, and co-morbidities. The advent of percutaneous aortic valve placement (TAVI) offers new hope for such patients. Of course, the application of any new technology requires a long period of theoretical accumulation, basic experiments and clinical exploration, and the development of TAVI is no exception. 1965 Davis was the first to propose the idea of percutaneous aortic valve replacement, and in 1992, Anderson in Denmark first performed the relevant animal tests by retrograde placement of the prosthetic valve into the ascending aorta of pigs through a catheter, which confirmed the feasibility of this method. feasibility. Subsequently, several different forms of valves for transcatheter implantation were invented, and in April 2002, Cribier et al. in France performed the first successful TAVI procedure in a male aortic stenosis patient, which became a milestone in the development of this technology. After more than 10 years of development, more than 45,000 patients have undergone TAVI surgery worldwide. This procedure sounds simple, but in practice it is still very complicated and has certain complications, the most common being conduction block, perivalvular fistula, and arterial puncture complications, so the risks of the procedure should be evaluated in detail before surgery, and the implementation process requires cardiac medicine, surgery, medical imaging The implementation process requires multidisciplinary collaboration between cardiology, surgery, medical imaging, anesthesiology, and intensive care, and a thorough consultation and treatment plan in advance. Large-scale clinical trials have demonstrated that TAVI surgery is more effective than medical therapy in prolonging life, improving quality of life, and reducing the incidence of heart failure in these patients, and that TAVI surgery is less invasive and results in faster recovery, making it the “valve replacement without the need for chest surgery”. A large, multicenter, randomized controlled study (PARTNER) looked at the prognosis of patients with severe calcific aortic stenosis in the TAVI and surgical groups and showed no significant difference in all-cause mortality between the two groups at 30 days and 1 year. The interventional group had a higher rate of vascular complications at 30 days compared with the surgical group, but lower rates of major bleeding and new-onset atrial fibrillation. Patients in the interventional group had significantly better symptoms at 30 days compared with the surgical group, and the mean length of stay was significantly better than in the surgical group. 1 year later both groups had improved symptoms and minute walk distance compared with the preoperative period, but there were no significant differences between the two groups. However, the latest issue of the European Journal of Cardiology published a follow-up of a group of 13,860 patients in Germany who underwent surgical open-heart aortic valve replacement (AVR) or percutaneous (TV) and transapical (TA) TAVI, showing that the incidence of stroke during hospitalization was 1.3%, 1.9%, and 1.7% for patients who underwent AVR, AVR+CABG, TV-TAVI, and TA-TAVI, respectively. 1.7%, and 2.3%, with mortality rates of 2.1%, 4.5%, 5.1%, and 7.7%, respectively. This suggests that the perioperative risk of conventional open-heart aortic valve replacement is lower than that of TAVI, and that TAVI would be an excellent alternative treatment for patients with severe aortic stenosis who are at very high risk for surgical intervention. As Professor Lawrence Cohn, Chairman of the American Board of Thoracic Surgery, says as he looks to the future: The future of cardiac surgery is full of fun, challenge and change for surgeons. Minimally invasive and interventional will be the future of cardiac surgery, especially for high-risk procedures like valve and bypass, and new technologies will give hope to patients with certain conditions that are traditionally contraindicated to surgery. But in any case, precise outcomes and maximum patient safety will be the primary principles in choosing treatment strategies for patients with valve disease combined with coronary artery disease.