key: cord-0816610-e82vegs6
authors: Elde, Stefan; de Biasi, Andreas; Woo, Y. Joseph; Burton, Elan
title: A Novel Alternative to The Commando Procedure: Constructing a Neo-Aortic Root by Anchoring to the Sewing Ring of the Replaced Mitral Valve
date: 2020-08-28
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.08.037
sha: 148b85e9917d9f5664fe1ba9a3795512c6ffcd96
doc_id: 816610
cord_uid: e82vegs6

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Here we report a novel technique for replacement of the mitral and aortic valves via an 25 aortotomy, on a patient with recent Stanford Type A aortic dissection and multi-valve infective 26 endocarditis. 27 28 Central Picture Legend: 29

Central picture legend: Replaced mitral valve with pledgets comprising neo-arotic root, 30 indicatedby ellipse. 31

The first aortic and mitral valve replacement via an aortotomy was reported by Carmichael et al 1 34 in 1983. Tirone David used the same exposure in 1997 2 to pioneer what came to be named the 35

Commando Procedure, which is to reconstruct the aorto-mitral curtain to allow double valve 36 replacement in cases of infective endocarditis. Here, we present a novel iteration of this 37 procedure using the mitral sewing ring as an anchor for the neo-aortic root. In this case, the two annuli were "hinged" together at the contact point between the sewing ring 89 segment around the bioprosthetic anterior mitral leaflet and the bioprosthetic non-coronary cusp 90 of the aortic valve. Provided that the surgeon is confident that the intertrigonal tissue and mitral 91 annulus is free of inflammatory damage and retains enough structural integrity to support these 92 anchoring sutures, this technique results in a durable repair without LVOT obstruction. 93

Considering the recent data on graft selection in endocarditis cases has shown similar outcomes 94 between bioprosthetic valves and homografts 5,6,7 , due to the urgent setting of this procedure and 95 the mitral valve requiring replacement, we elected a bioprosthetic aortic valve instead of an 96 aortic homograft. The advantage of this technique is that it simplified the approach to the 97 common problem of multi-valvular infective endocarditis and may spare critically ill patients the 98 morbidities and mortality risk associated with a prolonged cardiopulmonary bypass run. 

Aortic and Mitral Valve Replacement Through a Single 147

Transverse Aortotomy: A Useful Approach in Difficult Mitral Valve Exposure

Aortic and mitral valve replacement with reconstruction of 150 the intervalvular fibrous body

Transaortic Mitral Valve Replacement. The Annals of Thoracic Surgery

The incorporated 155 aortomitral homograft: A new surgical option for double valve endocarditis

Graft Selection for Aortic Root

Complex Active Endocarditis: Does It Matter? The Annals of Thoracic Surgery

Homografts Are Not the Cornerstone of Outcome. The Annals of Thoracic Surgery

Are homografts superior to conventional prosthetic 165 valves in the setting of infective endocarditis involving the aortic valve?