A thorough knowledge of pathophysiology of multiple and mixed valvular heart disease is a requirement for a stable perioperative care. We present anesthetic management of a 62-year male patient with bivalvular mixed lesions with gastric adenocarcinoma for gastrectomy. Fixed-output cardiac state, anemia, maintenance of hemodynamic goals for longer duration, and postoperative analgesia were the anesthetic concerns. Hemodynamic aberrations can be inevitable in such scenario. Proper understanding of the lesions, optimization, preparation, and planning for anticipation of adverse hemodynamic events plays a crucial role for expecting a better clinical outcome.