Affection of both mitral and aortic valves is a common finding in rheu­matic heart diseases, and when se­vere, it may necessitate replacement of both valves simultaneously. This study discusses factors affecting early and intermediate outcome after com­bined mitral and aortic valve replace­ment with or without tricuspid valve repair. The study included 55 pa­tients, 37 of them (67.3%) were males and 18 (32.7%) were females. Their mean age was 29.96 ( 8.44 years with 20 patients (36.4%) of them under 25 years age. There were 7 (12.7%) hos­pital mortalities, two of them (3.6%) were operative mortalities. The fac­tors that was found to be significant for early mortality were presence of AF (P = 0.002), advanced NYHA
class (P = 0.02), low EF (P = 0.005), low FS (P = 0.005), and high MPAP (P = 0.001). In the follow up period that ranged between 3 and 60 mo­nths, complications occurred in 14 pa­tients (29.2%), in the form of 5 endo­carditis, 4 persistant heart failure, 3 thromboemboiic events, and 2 antico-agulation related bleeding. There was 5 late mortalities (10.4%), 3 due to endocarditis and 2 due to persistent heart failure. The factors that were significant in predicting intermediate outcome were non-improvement of NYHA functional class (P = 0.002), nonperformance of mitral valve pres­ervation (P = 0.003), occurrence of complication (P = 0.001), develop­ment of arrhythmia (P = 0.012), per­sistence of low ventricular perfor­mance (P = 0.003), and persistence