Essen—Commando: How we do it

Abstract

In rare cases of extensive aortic root or mitral valve infective endocarditis (IE), severe calcification of the aortic and mitral valves, or double-valve procedures in patients with small aortic and mitral annuli, surgical reconstruction of the intervalvular fibrous body (IVFB) is required. A high mortality is generally associated with this procedure, and it is frequently avoided by surgeons due to a lack of experience. It is crucial to radically resect all tissues that are severely affected by IE to prevent recurrence in the patient. Our experience with the Commando procedure in patients with extensive double-valve IE involving the IVFB is presented in this article.

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

“…The rate of the reoperation for this procedure, however, remains high, at around 50% in the first 5 years across the mentioned studies. Recently, the group at Essen proposed a modified procedure renamed the Essen–Commando [ 57 ] ( Figure 3 ), involving the use of a Medtronic Freestyle stentless aortic root prosthesis for replacement. The group proposes that due to the flexibility, this prosthesis is able to offer optimum haemostatic activity and haemodynamic performance.…”

“…( C ) Final postoperative result: implanted aortic root prosthesis and right atrium closed with the anterior aspect of the pericardium patch. Reproduced from Zubarevich et al [ 57 ] with permission from the authors.…”

Endocarditis: Cardiac Surgery Treatment/A Thrilling Challenge in Cardiac Surgery

“…The objectives of surgery are as follows: remove possible sources of embolism; remove both infected tissue and foreign material; restore cardiac integrity, close any cavities; and often restore both the aortic mitral junction and the left ventricular outflow tract. Many surgical techniques have been used or invented both full sternotomy and minimally invasive approaches, but a clear long-term advantage of one technique has yet to be proven [29,30]. Surgery is currently performed in 50-60% of patients, and 6-month survival rates are >80%.…”

(Aortomitral continuity reconstruction in double-valve infective endocarditis)

“…Navíc z naší zkušenosti a zkušeností některých center poskytují lepší hemostatické vlastnosti, a tím výrazně snižují riziko pooperačního krvácení. 13,14 Jako alternativa se u mladých pacientů nabízí Rossova operace, 15 doposud ale v této indikaci není široce využívána. Je spíše specialitou některých center, které mají s touto technikou zkušenosti, a použitelná u pacientů bez extenzivního postižení aortálního kořene.…”