Risk factors for hospital death after combined valvular and coronary artery bypass surgery were examined in 131 consecutive cases between October 1988 and December 1999. These accounted for 8.0% of all 1,644 cases of coronary revascularization surgery and 15.3% of all 854 cases of valvular heart disease surgery. 84 men and 43 women underwent combined valvular and coronary artery bypass surgery. The mean age of the patients was 68.9 +/- 3.9 (22-86) years old. Numbers of cases comprised 58 undergoing aortic valve surgery, 63 undergoing mitral valve surgery, and 10 undergoing eight patients died during hospitalization after the operation: four due to cardiac death and four due to non-cardiac death. We studied pre- and perioperative risk factors for hospital death by means of multivariate analysis. As the major factors, ischemic mitral regurgitation, chronic renal failure, and duration of cardiopulmonary bypass were identified as three major predictors of hospital death. Ischemic mitral regurgitation was the strong predictor (p = 0.03) with 5 hospital deaths out of 38 ischemic mitral regurgitation cases (13.1%), whereas only 3 hospital deaths were seen in 93 other cases (3.2%) operated on in the same period. Over all operation results were not unfavorable, indicating that combined operations may be electively performed if severe coronary artery disease was present. The surgical results with ischemic mitral regurgitation are as yet not well documented and will require further study.