Surgery for combined lesions of the aortic and mitral valves

1. 1. Thirty cases of multiple valve repair or replacement are presented. 2. 2. Death occurred in 13.3 per cent. 3. 3. The survivors have had excellent clinical responses except in one instance. 4. 4. The aortic-mitral sequence is preferable, combined with local hypothermia and left coronary artery perfusion during the period of myocardial anoxia. 5. 5. There are indications for tricuspid replacement, but annular dilatation secondary to long-standing right heart failure itself is reversible and must not be construed as an indication for the simple maneuver of tricuspid replacement.