Introduction: The combination of mitral valve replacement (MVR) with coronary artery bypass grafting (CABG) is generally thought to have a greater early and late mortality than either procedure alone. The aim of this study is to review single center experience for the concomitant MVR and CABG. Patients and methods: This is a single center, retrospective, single cohort study, composes of consecutive cases. It included all the cases of combined operation of MVR and CABG. The patients were followed up for a median duration of two years (six months to four years). The data were collected from hospital records and registers of hospital statistics. The followings were obtained; socio-demographic data, information regarding clinical courses, intraoperative findings, and post-operative follow up data. Result: The study included 72 cases, the mean age was 56 years, 38 of them (53%) were males and 34 (47%) were female. The most common comorbidity was hypertension which was found in 24 patients (33%). The mean preoperative ejection fraction was 59%. Twenty-two patients (30.6%) had single graft, 21 patients (29.2%) underwent 3-vessel grafting, 16 patients (22.2%) had 2-vessel grafting, and 13 cases (18.1%) underwent 4-vessel grafting. The CPB duration ranged from 108 to 280 min with a mean of 182 min and cross-clamp time ranged from 80 to 186 min with a mean of 122 min. The most common complication was plural effusion which occurred in 8 cases (11.1%) and managed by aspiration. Overall mortality was 8.3% (4 patients). Conclusion: CABG and chordal-sparing and posterior leaflet replacement has favorable outcome, as well as minimizes the need of redo surgery as in repair.one of the best options for CAD and sever MR. Highlights

One of the major health problems causing defects or damage to one or more of the four heart valves [aortic, mitral, pulmonary, and tricuspid] is valvular heart disease [VHD]; it occurs due to congenital abnormalities or acquired pathology. It is a defect that results in weak heart valves and is therefore unable to function as precise pathways of the blood. The aim of the current study was to evaluate the ferroxidase activity of ceruloplasmin (Cp) and the lipid profile of valvular heart disease patients in sera. Ninety subjects were included in this study and 60 patients with HDV were divided into two subgroups according to the affected valve: 33 patients with aortic valve disease (AV) and 27 patients with mitral valve disease (MV group). In addition, 30 healthy individuals were registered in all groups as control(C) group Serum copper (Cu), total protein (TP), activity and specific activity of ferroxidase Cp, and lipid profile were measured. The results showed that there was a highly significant increase in patient (AV & MV) groups compared to the C group in activity, specific Cp and Cu activity levels. In addition, compared to the C group, triglyceride (TG) and very low density lipoprotein (VLDL) levels showed a highly significant increase in the AV and MV groups. No significant differences were found between patients and control groups in TP, Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C) & High Density Lipoprotein Cholesterol (HDL-C) levels. Likewise, for all parameters, there were no significant differences between the AV and MV groups. In conclusion, the high serum level of Cu and the activity of Cp ferroxidase may be considered to be a risk factor for VHD.

Coronary artery disease (CAD) is a clinical manifestation resulting from a narrowing of epicardial coronary arteries that supply blood and oxygen to the heart. Coronary artery disease is mostcommonlydue to atherosclerotic occlusion of the coronary arteries.Fibroblast growth factor 23 (FGF23) is a circulating peptide hormone secreted by bone cells,regulating phosphate and vitamin D metabolism. Several recent observational studies reported an independent association of circulating FGF23 with several cardiovascular disease (CVD) risk factors including left ventricular hypertrophy and vascular dysfunction,CVD progression and incident clinical CVD eventsand mortality.Apolipoprotein A1 (ApoA1) is the primary protein associated with high-density lipoprotein (HDL) particles,and plays a central role in reverse cholesterol transport. HDL cholesterol (HDL-C) and ApoA1 concentrations are inverlassely related to the risk for coronary artery disease. To find the role of fibroblast growth factor-23 in coronary artery disease and its associationwith Apolipoprotein-A1.This ccross –sectionalstudyincluded 42 elective patients attending the cardiology unit and the results of those patients were compared with 40 healthy control group. Blood samples were obtained for measurements of (FGF-23,troponin I,Apo-A1,total creatine kinase activity,urea,creatinine and lipid profile).The obtained results showed that there was a significant difference in serum FGF-23 in coronary artery disease (367.52 ± 128.52 pg/ml) as compared with the control (165.41 ± 53.65 pg/ml) (p< 0.05). There was a significant differences in Apo-A1 in coronary artery disease (2.03±0.90 mg/ml) as compared with the control (1.49 ± 0.25 mg/ml) (P = 0.014).There was a significant difference in age between CAD (58.66±8.85) and control group (51.125 ± 11.71) (P<0.005).There was a significant difference in TG where control (99.50 ± 21.59) differ from CAD (142.05 ± 66.24) (P = 0.006).According to the results that were shown in the tables, we can be conclude that higher levels of FGF23 and Apo-A1 may be associated with complications and mortality of CAD beside its associating with atherosclerosis in the Iraqi patients.

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