A Novel Technique for Simultaneous Double Annular Enlargement Using a Single Dacron Graft

Purpose: We describe a novel surgical technique for simultaneous enlargement of both the aortic and mitral annuli using a single Dacron (DuPont) graft. Description: The mitral prosthesis is first sutured within the graft, followed by trimming and fixation of the aortic prosthesis at a predetermined offset. The completed conduit is then implanted en bloc, allowing controlled, symmetric annular enlargement with precise geometric alignment. Evaluation: The technique was applied in a redo case after prior aortic valve replacement with a Freestyle (Medtronic) prosthesis in a patient presenting with prosthetic stenosis and mitral valve endocarditis. The procedure simplified complex reconstruction, reduced operative steps, avoided multiple patches, and preserved the geometry of the annuli and left ventricular outflow tract. The patient recovered uneventfully with excellent postoperative hemodynamics. Conclusions: This streamlined approach offers a practical and reproducible alternative for complex double-valve replacement with concomitant aortic root replacement involving the fibrous skeleton, particularly in patients with small annuli, heavy calcification, porcelain aorta, or prior surgery.