En bloc aortic root resection and Commando procedure for aortomitral bioprosthetic endocarditis

Early aortomitral bioprosthetic degeneration with acute endocarditis represents a surgical challenge because it requires thoughtful preoperative evaluation and anticipation of a complex and difficult reoperation. The aortomitral continuity and fibrous skeleton is often completely destroyed, and hence mandates a double valve replacement with recreation of a new aortomitral continuity, with a pericardial patch for instance. This technique was originally described by Tirone David, and was named Commando procedure by the Cleveland Clinic group.1 Approaching the aortic root in the setting of redo surgeries is a challenge in and of itself, and herein we describe our technique for en bloc aortic root resection, followed by a Commando procedure.