[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-418534-105":59,"doc-detail-418534-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","successful-double-valve-replacement-with-extensive-annular-enlargement-using-the-commando-procedure-case-report","Successful double valve replacement with extensive annular enlargement using the Commando procedure - case report","","Redo double valve replacement with extensive annular enlargement was performed in a 70-year-old woman using the Commando procedure. She had progressive heart failure 13 years after prior aortic valve replacement, mitral repair, and tricuspid annuloplasty. Echocardiography showed severe mitral stenosis and moderate aortic stenosis with moderate paravalvular leak. Annular enlargement with bovine pericardium enabled implantation of an Epic 27 mm mitral and an Inspiris 23 mm aortic bioprosthesis, avoiding patient–prosthesis mismatch. Postoperative recovery was uneventful with excellent hemodynamics and preserved options for future valve-in-valve therapy.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/successful-double-valve-replacement-with-extensive-annular-enlargement-using-the-commando-procedure-case-report/418534/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/successful-double-valve-replacement-with-extensive-annular-enlargement-using-the-commando-procedure-case-report/418534.png","ImageObject",300,407,{"name":92,"@type":93},"Kyle","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was annular enlargement performed during redo double valve replacement?","Question",{"text":112,"@type":113},"To avert patient–prosthesis mismatch (PPM) and enable implantation of appropriately sized bioprostheses in the setting of small aortic and mitral annuli.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What previous procedures did the patient undergo before the redo operation?",{"text":117,"@type":113},"Thirteen years earlier, she received aortic valve replacement, mitral repair, and tricuspid annuloplasty.",{"name":119,"@type":110,"acceptedAnswer":120},"How did the surgery affect postoperative cardiac performance?",{"text":121,"@type":113},"Postoperative echocardiography showed excellent hemodynamics, with low mean gradients for both aortic and mitral valves, and recovery was uneventful.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},418534,1790620436,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},3985741905716,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Journal of Surgical Case Reports, 2026, 1, rjaf1025  \n[https://doi.org/10.1093/jscr/rjaf1025](https://doi.org/10.1093/jscr/rjaf1025)  \nCase Report  \nCase Report  \nSuccessful double valve replacement with extensive annular enlargement using the Commando procedure ina patient with small aortic and mitral annuli after previous double valve surgery  \nAkito Inoue, Daisuke Takeyoshi *, Hidenobu Akamatsu, Tasuku Kawarabayashi, Jeonga Lee, Jun Maruoka, Kentaro Shirakura, Yuki Setogawa, Ryo Okubo  , Hiroyuki Miyamoto, Ryohei Ushioda  , Aina Hirofuji  , Shogo Takahashi, Shingo Kunioka  , Hiroyuki Kamiya  \nDepartment of Cardiac Surgery, Asahikawa Medical University, Midorigaoka 1-1-1, Asahikawa, Hokkaido 078-8510, Japan  \n*Corresponding author. Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi, Asahikawa, Hokkaido, Japan.  \nE-mail: [tkysdsk@gmail.com](tkysdsk@gmail.com)  \nAbstract  \nWe report a 70-year-old woman (body surface area 1 .42 m2) undergoing redo double valve replacement with extensive annular enlargement using the Commando procedure. Thirteen years earlier, she received aortic valve replacement (St. Jude Medical 19 mm), mitral repair (Physio Ring 24 mm), and tricuspid annuloplasty. She presented with progressive heart failure; echocardiography showed severe mitral stenosis (mitral valve area 0 .96 cm2) and moderate aortic stenosis with moderate paravalvular leak. To avert patient– prosthesis mismatch (PPM), both annuli were enlarged with bovine pericardium, permitting implantation of an Epic 27 mm mitral and an Inspiris 23 mm aortic bioprosthesis. Postoperative echocardiography demonstrated excellent hemodynamics (aortic effective orifice area 1 .76 cm2 , mean gradient 6 mmHg; mitral mean gradient 3 mmHg) . Recovery was uneventful, and she remains asymptomatic. Commando surgery enabled safe, simultaneous enlargement of both annuli, minimizing PPM, and preserving options for future valvein-valve therapy.  \nKeywords: commando procedure; double valve replacement; redo cardiac surgery; small aortic annulus; patient–prosthesis mismatch  \nIntroduction  \nThe Commando procedure enables simultaneous reconstruction of the aortic and mitral annuli and the aorto-mitral fibrous continuity. Initially developed for invasive endocarditis, it has become an option in reoperations requiring complex annular enlargement. Redo double valve replacement (DVR) with small annuli presents particular challenges: patient– prosthesis mismatch (PPM) is frequent, and valve-in-valve (ViV) transcatheter therapy may be compromised. We report a patient who underwent redo DVR with enlargement of both aortic and mitral annuli using the Commando procedure to avoid PPM and secure the potential for future ViV therapy.  \nCase report  \nA 70-year-old woman (body surface area [BSA] 1 .42 m2) had undergone aortic valve replacement (St. Jude Medical 19 mm mechanical aortic valve; Abbott, St. Paul, MN, USA), mitral valve  \nrepair (Physio Ring 24 mm; Edwards Lifesciences, Irvine, CA, USA), and tricuspid annuloplasty with De Vega technique 13 years earlier. Over the previous two years, she experienced progressive heart failure despite optimized medical therapy. Echocardiography demonstrated severe mitral stenosis with a mitral valve area of 0 . 96 cm2 , markedly restricted leaflets, and calcification of both commissures. The aortic prosthesis showed a peak velocity of 3.3 m/s with moderate stenosis and moderate paravalvular regurgitation (Fig. 1) . Given persistent symptoms and limited efficacy of medical management, surgical intervention was planned. Her comorbidities included hypertension and chronic atrial fibrillation.  \nThe operation was performed through a redo median sternotomy. Cardiopulmonary bypass was established using ascending aortic cannulation and bicaval drainage. After cardioplegic arrest, the previous aortic prosthesis was explanted along the old aortotomy. The incision was then extended through the left-noncoronary commissure ","cbCaiaCi1bvYcqcD","https://ap.wps.com/l/cbCaiaCi1bvYcqcD","pdf",419599,"English","# Abstract\n# Introduction\n# Case report","[{\"question\":\"Why was annular enlargement performed during redo double valve replacement?\",\"answer\":\"To avert patient–prosthesis mismatch (PPM) and enable implantation of appropriately sized bioprostheses in the setting of small aortic and mitral annuli.\"},{\"question\":\"What previous procedures did the patient undergo before the redo operation?\",\"answer\":\"Thirteen years earlier, she received aortic valve replacement, mitral repair, and tricuspid annuloplasty.\"},{\"question\":\"How did the surgery affect postoperative cardiac performance?\",\"answer\":\"Postoperative echocardiography showed excellent hemodynamics, with low mean gradients for both aortic and mitral valves, and recovery was uneventful.\"}]","Successful double valve replacement with extensive annular enlargement using the Commando procedure - case report | PDF",1790613522]