Introduction: Patients with advanced multivalvular disease (AMVD) and left ventricular dysfunction carry usually a higher in hospital mortality. However, long-term survival results improved in some causes. Design: Retrospective study, teaching hospital based. Methods: 82 patients (59 men and 23 women) mean age 44,5±13,6 years with left ventricular ejection fraction (LVEF) ≤ 45% underwent multiple valve surgery from 1994 to 2016. The most common etiology was rheumatic valve disease (89%). 90, 2% of patients were in NYHA class III-IV. Mean LVEF was 38, 4±6, 3%. Triple valve surgery was performed in 38 (46, 4%) cases and double valve surgery was performed in 44 (53, 6%) cases. All tricuspid procedures were conservative (51 cases; 62, 2%): DeVega in 22 (43, 1%) cases and Carpentier Edwards ring in 29(46,9%) cases. A logistic regression analysis was used to identify the determinants factors of early mortality. Results: In-hospital mortality was 17% (14/82).In multivariate analysis, factors influencing operative mortality rate were: preoperative renal failure (OR 9.6, 95%CI 1.28-72.4, p=0,027) and LOS (OR 19.8, 95%CI 1.8-218.4, p+0,015). Follow-up was 35% complete and follow-up period was 48 months (range 12-108). There is a significant change in NYHA functional class (p<0, 0001) and most survivors showed an increase LVEF (p<0, 0001). Conclusion: Multiple valve surgery in patients with AMVD and left ventricular dysfunction can be performed despite early mortality rate. But the good late results justify surgical indication and those patients should not be denied on the basis of low ejection fraction alone.