A novel alternative to the Commando procedure: Constructing a neo-aortic root by anchoring to the sewing ring of the replaced mitral valve

Commentary: Keeping it simple to avoid going commando

“…Surgical treatment of endocarditis is predicated on thorough debridement of infected tissue; therefore, reconstruction is dependent on the remaining viable tissue. It is important to note that in this case, “the tissue of the dome of the left atrium was intact” 1 and the fibrous trigones were uninvolved. 1 …”

“…It is important to note that in this case, “the tissue of the dome of the left atrium was intact” 1 and the fibrous trigones were uninvolved. 1 …”

“…Burton and colleagues 1 present an interesting solution to a challenging problem. At the onset, facing a patient whose prior aortic valve prosthesis and ascending graft have become grossly infected represents tremendous risk.…”

Commentary: Even simplified, it is still a commando operation

“…In this issue of the Journal , Elde and coauthors 9 propose an interesting iteration of both approaches, and the results seem promising. In their approach, both valves were replaced via an aortotomy without the need to open the dome of the left atrium, the aortic bioprosthetic valve was sewn into an hemashield graft, and the aortic valve sewing ring was secured to the remaining left ventricular outflow tract and to the sewing ring of the mitral bioprosthesis.…”

“…6 Recent efforts have been made to simplify the operation by using prostheses that incorporate extra tissue to aid suture anchoring instead of cryopreserved homografts and by providing less extensive access to the cardiac chambers. 7,8 In this issue of the Journal, Elde and coauthors 9 propose an interesting iteration of both approaches, and the results seem promising. In their approach, both valves were replaced via an aortotomy without the need to open the dome of the left atrium, the aortic bioprosthetic valve was sewn into an hemashield graft, and the aortic valve sewing ring was secured to the remaining left ventricular outflow tract and to the sewing ring of the mitral bioprosthesis.…”