JACC Case Rep. 2025 Nov 22:106133. doi: 10.1016/j.jaccas.2025.106133. Online ahead of print.

ABSTRACT

BACKGROUND: Redo aortic and mitral valve surgery with severe mitral annular calcification (MAC) and intervalvular fibrous body destruction is highly challenging; the Commando procedure is often a last resort.

CASE SUMMARY: A 59-year-old man with prior mechanical aortic and mitral valve replacements presented with hemolytic anemia due to a mitral paravalvular leak. Imaging showed severe MAC and tricuspid regurgitation. Intraoperatively, massive calcification and insufficient native tissue precluded standard anchoring for implantation of the new mechanical valves. In addition to the standard Commando procedure, a bovine pericardial patch was used reconstruct a neo-mitral annulus. Recovery was uneventful.

DISCUSSION: Bovine pericardial patches offer structural support when native tissue is inadequate, facilitating safe and durable outcomes in complex redo valve procedures.

TAKE-HOME MESSAGES: This case illustrates a viable surgical strategy for high-risk redo double-valve procedures. Bovine patch reconstruction enabled stable valve implantation and functional restoration in the setting of extensive MAC.

PMID:41273326 | DOI:10.1016/j.jaccas.2025.106133