How to Do It: The Commando Operation for Reconstruction of the Fibrous Skeleton with Double Valve Replacement

  • Brian Lima Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
  • Themistokles Chamogeorgakis Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
  • Juan C MacHannaford Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
  • Aldo Rafael Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
  • Gonzalo V Gonzalez-Stawinski Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
  • Brian Lima, MD Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas

Abstract

Infiltrative processes that extend into the intervalvular fibrosa, such as infection or calcification, often mandate a complex reconstructive procedure known as the Commando operation. First described less than 20 years ago, this operation is not widely implemented, with experience limited to a few select centers. This report provides a detailed summary of our approach to this intricate procedure.

Author Biographies

Brian Lima, Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas

Director of Clinical Research in Heart Transplantation and Mechanical Circulatory Support, Baylor University Medical Center

Surgical Director of Mechanical Circulatory Support, The Heart Hospital Baylor Plano

Associate Professor of Surgery, Texas A&M Health Science Center College of Medicine

Themistokles Chamogeorgakis, Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
Staff Surgeon at Cardiac and Thoracic Surgery at Baylor University Medical Center
Juan C MacHannaford, Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
Staff Surgeon at Cardiac and Thoracic Surgery at Baylor University Medical Center
Aldo Rafael, Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
Staff Surgeon at Cardiac and Thoracic Surgery at Baylor University Medical Center
Gonzalo V Gonzalez-Stawinski, Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
Staff Surgeon at Cardiac and Thoracic Surgery at Baylor University Medical Center

References

David TE, Kuo J, and Armstrong S. 1997. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body. J Thorac Cardiovasc Surg 114:766-72.

Davierwala PM, Binner C, Subramanian S, et al. 2014. Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. Eur J Cardiothorac Surg 45:146-52.

De Oliveira NC, David TE, Armstrong S, Ivanov J. 2005. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes. J Thorac Cardiovasc Surg 129:286-90.

Forteza A, Centeno J, Ospina V, et al. 2015. Outcomes in aortic and mitral valve replacement intervalvular fibrous body reconstruction. Ann Thorac Surg 99:838-46.

Kim SW, Park PW, Kim WS, et al. 2013. Long-term results of aortomitral fibrous body reconstruction with double-valve replacement. Ann Thorac Surg 95:635-41.

Pettersson GB, Hussain ST, Ramankutty RM, Lytle BW, Blackstone EH. 2014. Reconstruction of the fibrous skeleton: Technique, pitfalls, and results. Multimed Man Cardiothorac Surg, June 18.

Published
2016-12-21
Section
Articles