title: Modified surgical sequence in aortic and mitral valve replacement with or without tricuspid valve repair or replacement.
abstract: A mitral prosthesis, when implanted, can distort the aortic annulus, forcing to downsize the aortic prosthesis. Changing the sequence of tying the sutures (the aortic prosthesis first, then the mitral prosthesis) allows to insert an aortic true-sized prosthesis. In case of associated tricuspid valve surgery, the aortic prosthesis protrudes over the anteroseptal commissure area. The sutures on the tricuspid annulus can be passed before the aortic prosthesis is secured in place.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia am.calafiore@gmail.com.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Angela Lorena
authors.initials: AL
authors.lastname: Iaco
authors.affiliation: Department of Cardiology, Prince Sultan Cardiac Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Shah
authors.affiliation: Institute of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery; D014261:Tricuspid Valve / Q000601:surgery
keywords: Mitral and aortic valve replacement; Tricuspid repair