The “UFO” procedure

Abstract

The term "UFO" is not a medical term, but helps emphasize the extremely high degree of complexity of a surgical repair that is akin to someone observing an unidentified flying object. It involves replacement of the mitral and aortic valves with reconstruction of the intervalvular fibrous body (IVFB). Specific pathologies that render this operation necessary usually involve the IVFB, which is located between the aortic and mitral valves and constitutes a major portion of the fibrous skeleton of the heart. Patients that most often require such an operation are those with extensive aortic and mitral valve endocarditis with perivalvular extension into the IVFB. Other infrequent situations such as severe aortic and mitral annular calcification involving the IVFB, double valve replacement in patients with extremely small aortic and mitral annuli or double valve reoperations in which no IVFB is available following excision of both valves, necessitating the UFO procedure. The basic surgical principle has been first described as early as 1980. Depending on the extent of excised tissue due to the underlying disease, modifications and additional complex repair techniques have to be adopted. It is of utmost importance to have adequate visibility and exposure. There are certain important structures, which are at a risk of either injury or neglect, that can result in development of life-threatening complications during this operation, which a surgeon should be aware of. A step by step description of the "UFO" procedure can help guide the surgeon to perform this operation safely and efficiently. Although clinical complications are high, they are often related to the underlying disease and not specifically to the procedure itself, if performed perfectly.

Systematic approach to diagnosis and management of infected prosthetic grafts in the proximal aorta

“…All five deaths were within 24 h and in the operated redo Bentall Group giving a mortality of 31%. Although the Group performed six “Commando” or “UFO” procedures for endocarditis, surprisingly none were for prosthetic valve endocarditis of a previous graft 12 . For these reasons and the associated mortality risk, the strategy is reserved for patients with hard indications.…”

Essen—Commando: How we do it

“…These areas are at risk of bleeding after the reconstruction is complete, especially in cases of IE where the tissues can be more fragile. Sandwiching the patch between the sewing ring of the mitral valve prosthesis and the native annulus before lowering the prosthesis and then tying the suture helps to prevent leakage in this area and provide hemostasis 6 . The anterior aspect of the double‐patch is commonly used to repair the non‐coronary aortic sinus, but as this technique includes aortic root replacement, the anterior aspect of the patch is used to close the right atrium without tension on both the implanted valve prostheses.…”

(Aortomitral continuity reconstruction in double-valve infective endocarditis)

“…2 -Vegetace na AML (červená šipka vlevo) a obraz mitrální regurgitace v 3D projekci na TEE (červená šipka vpravo) podobnost prožitku ze zhlédnutí daného výkonu s pozorováním mimozemského objektu. 5 Dnes je rovněž známá jako "Commando procedure".…”