Management of multivalvular heart disease.

Compared to single valve replacement, multivalvular procedures--which in the great majority of cases are mitral-aortic valve implantations--represent a major technical challenge as they theoretically increase the risk of early and late complications, related to or induced by the artificial device. In the earlier years of valve replacement surgery, there were therefore restrictions on double and especially triple valve replacement, and such surgery was often postponed. This gives sufficient cause to review the present incidence of complications and reoperation rates and the operative risk in multivalvular procedures.