Between July 1, 1971, and March 1, 1975, 45 patients underwent combined valvular and coronary artery operation. Aortic valve disease was present in 30 patients, mitral valve disease in 13, aortic and mitral valve disease in 1, and tricuspid valve disease in 1. The average age was 57 years. Seventeen patients were in New York Heart Association Functional Class IV. Seventeen patients had had a previous myocardial infarction. Significant coronary artery disease was an unexpected finding at the time of coronary angiography in 14 patients. The average number of grafts inserted was 2.5 per patient. The grafts were placed prior to valve replacement, and periods of myocardial ischemia were kept at a minimum by maintaining coronary perfusion throughout the operation. Operative mortality was 16%; late mortality was 8%. Perioperative myocardial infarction occurred in 2 patients.