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Published on: March 28, 2025
A Novel Technique for Simultaneous Double Annular Enlargement Using a Single Dacron Graft
Majed Tolah1,2, Dragan Opacic1, Mohammad Sharaf1
1Department of Cardiothoracic Surgery, Heart and Diabetic Center of North Rhine-Westphalia, Bad Oyenhausen, Germany.
Annals of Thoracic Surgery Short Reports
|June 10, 2026
Summary
A new surgical technique uses a single graft for simultaneous aortic and mitral annulus enlargement. This method simplifies complex valve replacements, offering a reproducible alternative for challenging cases.
Area of Science:
- Cardiovascular Surgery
- Surgical Innovation
- Prosthetic Valve Surgery
Background:
- Complex valve replacement often requires multiple procedures.
- Enlarging small or calcified annuli presents surgical challenges.
- Prior aortic valve replacement can complicate subsequent mitral valve surgery.
Purpose of the Study:
- To present a novel surgical technique for simultaneous aortic and mitral annulus enlargement.
- To simplify complex double-valve replacement procedures.
- To provide a reproducible method for challenging annular reconstructions.
Main Methods:
- A single Dacron graft is used for both aortic and mitral annulus enlargement.
- Mitral prosthesis is sutured within the graft, followed by aortic prosthesis fixation.
- The entire conduit is implanted en bloc for controlled, symmetric enlargement and alignment.
Main Results:
- The technique was successfully applied in a redo case with prosthetic stenosis and endocarditis.
- The procedure simplified reconstruction, reduced operative steps, and avoided multiple patches.
- Excellent postoperative hemodynamics were achieved with preserved ventricular outflow tract geometry.
Conclusions:
- This streamlined approach is a practical alternative for complex double-valve replacement with aortic root replacement.
- It is particularly beneficial for patients with small annuli, heavy calcification, porcelain aorta, or prior surgery.
- The technique ensures precise geometric alignment and controlled annular enlargement.
