Recently, the Department of Thoracic and Cardiovascular Surgery of our hospital successfully performed a combined mitral valve replacement and coronary artery bypass surgery for a patient with rheumatic heart disease combined with coronary heart disease. The patient recovered well after the surgery and was discharged from the hospital. This is another difficult heart surgery completed by our Thoracic and Cardiovascular Surgery Department. 54-year-old Ms. Zhang started to have chest tightness, shortness of breath, cough and sputum three months ago. She had to stop walking just a few meters because of the severe palpitations and shortness of breath, and was still not improving despite multiple treatments. After a detailed examination by Director Gong Guihong and a consultation with experts from the department, Ms. Zhang was diagnosed with “rheumatic heart disease, severe mitral valve stenosis and incomplete closure”. After systematic treatment, the cardiac insufficiency was corrected and the pulmonary infection was significantly controlled. A coronary angiogram showed that the patient also had severe coronary artery disease, with anterior descending branch stenosis reaching 75%. After consultation, the patient was referred to the thoracic and cardiovascular surgery department to prepare for surgical treatment. In view of the patient’s advanced age, critical condition and frailty, it was necessary not only to replace the diseased mitral valve, but also to perform bypass grafting (commonly known as coronary artery bypass grafting) on the stenosed coronary artery. Both cardiac surgical procedures are characterized by high difficulty and risk. A detailed surgical procedure and extracorporeal circulation management plan was developed with the operating room of the Department of Anesthesiology before the operation. The surgery was eventually performed successfully, and after a 2-day transition in the ICU and transfer back to the ward, the patient recovered rapidly. Coronary heart disease combined with valvular disease is an extremely serious adult heart disease. The stenotic coronary arteries leave the myocardium with insufficient oxygen supply, while the complex valvular disease increases the cardiac load and myocardial oxygen consumption, further aggravating the ischemic and hypoxic state of the affected myocardium. Patients with coronary artery disease can be treated by three types of treatment: traditional medication, coronary intervention, and coronary artery bypass grafting. The outstanding advantage of bypass surgery is that it can completely treat occluded coronary lesions, with a high long-term patency rate and less need for re-blooding. However, coronary artery bypass grafting requires open-heart surgery under general anesthesia and extracorporeal circulation, which is more invasive and results in a longer hospital stay. In view of the fact that the patient also had heart valve disease, it was decided to perform heart bypass surgery for her at the same time, so that the arterial blood in the aorta bypassed the original stenotic segment of the coronary artery and reached the distal coronary artery directly through the “bridge vessel” to restore normal blood flow and improve the symptoms of myocardial ischemia.