Combined Manouguian-Guiraudon Approach for Double Valve Replacement: The Commando Revisited

Abstract

Double annular enlargement is a valuable technique for the cardiac surgeon, and it should be in his or her armamentarium when dealing with challenging aortic and mitral valve cases. The technique requires reconstruction of the intervalvular fibrosa. It redesigns the inflow and outflow of the left ventricle in a way that serves both annular enlargement and satisfactory valve replacement with resulting low gradients. Here, we describe our preferred operative steps.