Commando and Hemi-Commando Procedures for Prosthetic Valve Endocarditis Involving Mitral-Aortic Fibrosa

This video submission is from the 2025 CTSNet Instructional Video Competition. Watch all entries from the competition, including the winning videos.  

Prosthetic valve endocarditis (PVE) is a life-threatening condition that often leads to re-do surgery due to the failure of medical treatment or extensive involvement of surrounding tissues. In particular, some cases of aortic or mitral PVE can lead to damage of the mitral-aortic intervalvular fibrosa (MAIF), resulting in the formation of a pseudoaneurysm or an abscess. Although procedural and periprocedural risks for these patients are very high, surgery remains the only option to treat such disruptive pathologies. The Commando and Hemi-Commando procedures are challenging techniques that involve the reconstruction of the MAIF, aortic valve or root replacement, and either mitral valve replacement or repair. In this video, the authors present two cases of PVE with MAIF involvement treated with Commando and Hemi-Commando procedures, respectively, from clinical presentation to a step-by-step procedure. 

References

1. Misfeld M, Davierwala PM, Borger MA, Bakhtiary F. The "UFO" procedure. Ann Cardiothorac Surg. 2019 Nov;8(6):691-698. doi: 10.21037/acs.2019.11.05. PMID: 31832364; PMCID: PMC6892712.
2. Davierwala PM, Binner C, Subramanian S, Luehr M, Pfannmueller B, Etz C, Dohmen P, Misfeld M, Borger MA, Mohr FW. Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. Eur J Cardiothorac Surg. 2014 Jan;45(1):146-52. doi: 10.1093/ejcts/ezt226. Epub 2013 May 3. PMID: 23644706.

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.