One hundred eleven patients underwent their second to fifth open heart operation, excluding isolated coronary revascularization. The procedures included repeat, single and multiple valve replacements, concomitant redo valve surgery, plus aortic root, and/or aortic arch reconstruction with or without coronary bypass graft. Six patients had heart transplantation as the final procedure. The article is based on the analysis of the experience of one surgeon with particular emphasis on technical considerations and factors enhancing outcome. There were two deaths for an early (hospital--30 days) mortality of 1.8%. There were three sternal wound complications. Two patients suffered cerebrovascular accident (one with permanent residual deficit), and one patient required reoperation for tamponade. The text contains a relatively detailed description of the technical maneuvers applied for several different categories of procedures used.