The coupling valve graft: a procedure for double-valve replacement.

Coupling valve grafting, a procedure to enlarge the annulus of the aortic valve and of the mitral valve simultaneously, is described. It consists of extending the J-shaped aortotomy through the middle of the noncoronary cusp into the superior aspect of the left atrium and down the anterior leaflet of the mitral valve. Then the mitral and aortic valves are replaced with a coupling valve graft, a vascular prosthesis attached to two prosthetic valves. This technique seems to be most suitable for patients in whom the valves of both annuli are narrow, as is often seen in aortic and mitral stenosis. Since both valve annuli can be enlarged greatly in this procedure, combinations of prosthetic valve sizes can be freely chosen for the two valves.