Successful combined aortic and mitral valve replacement with biological prostheses using the COMMANDO procedure under conditions of narrow valve rings and severe calcification via a mini-sternotomy approach: a case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Simultaneous acquired aortic and mitral valve disease complicated by severe calcification and anatomically narrow rings poses a significant technical challenge in adult cardiac surgery. Implantation of small-sized prostheses under standard double-valve replacement risks prosthesis-patient mismatch (PPM), associated with elevated transprosthetic gradients, impaired regression of left ventricular hypertrophy, and reduced long-term survival. Reconstruction of the aorto-mitral fibrous continuity — the COMMANDO procedure — is the definitive surgical strategy to circumvent this limitation. Case presentation: A 73-year-old female with severe biValvular calcification and critically narrow annular dimensions (aortic 21 mm; mitral 34 mm) underwent combined aortic and mitral bioprosthetic replacement via the COMMANDO technique through a partial upper mini-sternotomy. An autopericardial patch was used to reconstruct the intervalvular fibrosa and simultaneously enlarge both annuli. Hancock II bioprostheses were implanted (mitral 29 mm; aortic 25 mm). Cardiopulmonary bypass time was 150 minutes; cross-clamp time 135 minutes; intraoperative blood loss 200 mL. The heart resumed sinus rhythm spontaneously without inotropic support. The patient was extubated on postoperative day 1 and discharged on day 9. Follow-up echocardiography confirmed excellent prosthetic function (aortic PGmean 11 mmHg; mitral PGmean 3 mmHg; no paravalvular leak) with definitive avoidance of PPM (aortic iEOA 1.85 cm2/m2; mitral iEOA 2.5 cm2/m2). Conclusion: The COMMANDO procedure executed through a partial upper mini-sternotomy is safe and technically feasible in elderly patients with severe biValvular calcification and narrow annular dimensions, enabling optimal prosthesis sizing, definitive PPM prevention, and excellent early haemodynamic outcomes. Keywords: acquired heart valve disease; aortic valve stenosis; mitral valve stenosis; COMMANDO procedure; aorto-mitral fibrous continuity reconstruction; prosthesis-patient mismatch; biological prosthesis; mini-sternotomy; minimally invasive cardiac surgery; case report
Source: Georgian Medical Journal
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7204129112