The patient was a male, 75 years old, admitted to the hospital with “chest tightness for 2 years, aggravated with anterior heart pain for 6 months”, and was diagnosed with “1, coronary atherosclerotic heart disease, unstable angina pectoris, 2, mitral valve prolapse, mitral valve insufficiency (severe), 3, aortic valve insufficiency (severe), and cardiac function class III (NYHA classification). unstable angina 2, mitral valve prolapse, mitral valve insufficiency (severe) 3, aortic valve insufficiency (severe), cardiac function class III (NYHA classification) 4, pulmonary hypertension (severe) 5, hypertensive disease (very high risk) 6, diabetes mellitus (type 2) 7, emphysema 8, multiple cerebral infarction, cerebral atrophy”. The patient had special criticality, mainly including: 1, advanced age (75 years old); 2, poor physical condition (height 180 cm, weight only 63 kg); 3, complex and severe lesions: multiple valve lesions, combined coronary artery disease; 4, severe coronary artery disease: severe stenosis (70%-90%) in the anterior descending branch, diagonal branch, obtuse marginal branch, and posterior descending branch; 5, poor cardiac function: significantly limited mobility, walking The quality of life is severely reduced; 6. serious comorbidities: especially severe pulmonary hypertension and multiple cerebral infarction; 7. huge surgical risks and high mortality: long operation time, extracorporeal circulation and aortic block (cardiac arrest) time, and the latter is proportional to the mortality; 8. many intraoperative and postoperative complications: heart failure, intractable arrhythmia, pulmonary intraoperative and postoperative complications: heart failure, intractable arrhythmia, pulmonary failure, coma, renal failure, etc. After discussion, the whole department unanimously agreed that the patient was an elderly and critical case with indications for surgery and no absolute contraindications, and the risk of surgery was great. Combined with the strong request of the patient and his family and the comprehensive clinical level of cardiac surgery in our hospital, surgical treatment was possible. After adequate preoperative preparation, especially improving cardiac function, enhancing nutrition, strengthening pulmonary function exercise, and specifically formulating surgical treatment plan and extracorporeal circulation management plan. With Prof. Zhang for and Associate Prof. Gu Xinghua in charge, aortic valve replacement (AVR) + mitral valve replacement (MVR) + coronary artery bypass grafting (bypass) (CABG, three-branch bridge) was performed in November 2009 under general anesthesia in low-temperature extracorporeal circulation. Special intraoperative management included: systemic hypothermia (28°C), maintenance of high level of perfusion blood pressure (80 mmHg), maintenance of high level of PaO2 (300-400 mmHg), direct coronary artery perfusion + retrograde coronary venous sinus perfusion + direct perfusion of cold blood high potassium myocardial protective fluid (1 perfusion every 20 minutes) by vascular bridge, intraoperative intermittent lung expansion, application of imported artificial membrane lung, imported Artificial filter, high-dose methylprednisolone, cytarabine, ganglioside, etc. were also applied. The operation was successful and the patient was returned to the ward with high surgical skills, assisted by extracorporeal circulation for 4 hours and aortic blockade (cardiac arrest) for only 3 hours. The patient’s vital signs were extremely unstable for 48 hours after the operation, and symptoms of brain damage appeared, and the first time off the ventilator was unsuccessful. Members of the surgical team stayed in the extracardiac ward for 50 hours after the operation, observing changes in the patient’s condition and dealing with them in a timely manner. After treatment with cardiac diuresis, improvement of cardiac function, adequate nutritional support, application of antibiotics, myocardial nutrient drugs and cerebral protective drugs, prevention of pulmonary inflammation, stress gastrointestinal bleeding and other complications, as well as careful care by ward nurses, the patient’s condition was stabilized and he was transferred out of the intensive care unit on the 4th postoperative day and discharged on the 12th postoperative day with cure. He was hospitalized for 28 days in total.