Modified Commando procedure using a double valve composite through an aorto-annulo-septotomy

Interdiscip Cardiovasc Thorac Surg. 2024 Jan 2;38(1):ivad213. doi: 10.1093/icvts/ivad213.

Abstract

Double valve replacement of aortic and mitral valves with intervalvular fibrous body reconstruction (Commando procedure) is a challenging operation. Particularly in redo surgery for prosthetic valve endocarditis, special techniques are needed for approaching and reconstructing the valve complex. We performed a modified Commando procedure using a double valve composite through an aorto-annulo-septotomy. This approach provided a good field of vision at the combined aortic and mitral annuli without incising the left atrial roof. The double valve composite with four-layer patch wings was useful for performing double valve replacement en bloc and aorto-annulo-septotomy closure serially. Using these techniques, we successfully performed the Commando procedure for complicated prosthetic valve endocarditis.

Keywords: Commando procedure; Double valve replacement; Intervalvular fibrous body; Prosthetic valve endocarditis.