Modified surgical sequence in aortic and mitral valve replacement with or without tricuspid valve repair or replacement.

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.