As cardiac surgery matures, cardiac surgeons are treating patients with more complex pathology than routine coronary artery bypass or single valve replacement. An appreciation for the interaction of various structures of the heart, reoperative surgery, endocarditis, and the ability to better treat inflammatory diseases challenges the discipline. This chapter will focus on diseases that affect multiple valves, secondary changes in valves due to upstream valvular disease, and the techniques and considerations in addressing multiple valve repair and replacement.
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