Abstract
Coronary Artery Bypass Grafting (CABG) is a usual procedure to treat patients with coronary artery disease with relatively low mortality rates in best centers. The need for additional procedures further increases the risks.
Objectives: The objectives of this study is to present our humble experience with such procedures, to alleviate both doctor and patients concern when needing such an intervention.

Methods: This is a retrospective clinical case series study of patients admitted to Mosul center for cardiology and cardiac surgery from 13-5-2012 till 1-5-2016.

Results: Off all patients referred for CABG, 13.4% needed an additional procedure including LV aneurysm repair, AVR, MVR, DVR and aortic aneurysm repair. Male to female ratio was 3.8:1, 89.6% of patients were in NYHA class 3, 37.9% of patients were diabetic, 65.5% had a reduced EF%, 65.5% had associated respiratory problems and 13.8% had renal impairment. 44.8% needed three coronary grafts, 27.6% needed two grafts, 20.7% needed a single graft and 6.9% needed four grafts. Our median aortic cross clamps was 68.1 min, and our median perfusion time was 113.6 min. Post-operative complications included arrhythmias in 44.8%, prolonged hospital stay in 34.5%, increased postoperative serum creatinine in 27.6%, prolonged mechanical ventilation in 17.2%, prolonged ICU stay in 17.2%, oliguria in 13.8%, low cardiac output in 6.9%, bleeding in 3.4%, with a mortality of 3.4%.

Conclusion: CABG with additional procedures is a safe and common surgical condition with risks and complications comparable to that of CABG alone. More interest should be paid on patient and doctor education on the benefit of proper timing of surgery. And our surgical teams need further training and education to try and further shorten our operative time.

Key words: CABG, Coronary Artery Bypass Grafting, MVR, Mitral Valve Replacement, AVR, Aortic Valve Replacement, Double Valve Replacement, DVR, LV Aneurysmal Repair.