Commando procedure in a radiated chest.

Abstract

Patients with a history of mantle radiation are prone to developing calcific valve disease. In patients with concurrent aortic and mitral valve disease, calcification at the aorto-mitral curtain and mitral annulus can pose technical challenges for double valve replacement. The Commando procedure offers a simplified method to avoid placing annular suture through calcium and facilitates implantation of larger valves. Although prior publications1 by the Cleveland Clinic describe surgical technique in the setting of endocarditis, in this report we outline a technique specifically to address calcific valve disease.