Abstract
This case highlights a modified Bentall combined with Commando procedure in a patient with extensive cardiac calcification. Preoperative imaging revealed severe valvular dysfunction, a low left coronary ostium, and heavy calcification of the intervalvular fibrous body. Given the patient's small, calcified annuli, reconstruction of the intervalvular fibrous body was required. Aortic annular enlargement was achieved with a patch, thus allowing implantation of a tilted aortic valve-conduit prosthesis. Dual incisions were used for optimal exposure. This case demonstrates the feasibility of combining Bentall and Commando procedures in complex valvular disease.