In these reports, subjects with CKD undergoing CABG had an increased inci- dence of periprocedural complications, including mediastinitis, need for blood transfusion, prolonged ventilation, reoperation, stroke, and increased length of hospital stay.1210 6.7. Patients With Concomitant Valvular Disease: Recommendations Class I 1. Patients undergoing CABG who have at least mod- erate aortic stenosis should have concomitant aortic valve replacement.1217 1220 (Level of Evidence: B) 2. Patients undergoing CABG who have severe ische- mic mitral valve regurgitation not likely to resolve with revascularization should have concomitant mi- tral valve repair or replacement at the time of CABG.1221 1226 (Level of Evidence: B) Class IIa 1. In patients undergoing CABG who have moderate ischemic mitral valve regurgitation not likely to resolve with revascularization, concomitant mitral valve repair or replacement at the time of CABG is reasonable.1221 1226 (Level of Evidence: B) Class IIb 1. Patients undergoing CABG who have mild aortic stenosis may be considered for concomitant aortic valve replacement when evidence (eg, moderate severe leaflet calcification) suggests that progression of the aortic stenosis may be rapid and the risk of the combined procedure is acceptable. (Level of Evi- dence: C) 6.8. Patients With Previous Cardiac Surgery: Recommendation Class IIa 1. In patients with a patent LIMA to the LAD artery and ischemia in the distribution of the right or left circumflex coronary arteries, it is reasonable to recommend reoperative CABG to treat angina if GDMT has failed and the coronary stenoses are not amenable to PCI.380,1227 (Level of Evidence: B) 6.8.1. 