Modified commando procedure in complicated infective endocarditis \u2500 a case series

Posung Chen,Ichen Chen,Tingchao Lin,Chungyi Chang,Yicheng Chuang

doi:10.1186/s13019-021-01480-4

Abstract

BackgroundComplicated infective endocarditis (IE) with perivalvular abscess and destruction of intervalvular fibrous body (IFB) has high mortality risk and requires emergent or urgent surgery mostly.Case presentationWe presented four patients with complicated infective endocarditis combined with perivalvular abscess and IFB destruction. Three patients had prosthetic valve endocarditis and one patient had native valve endocarditis. They all received modified Commando procedure successfully. No surgical mortality or re-exploration for bleeding.ConclusionsWe suggest that modified Commando procedure may have some benefit in improving survival rate of patients with complicated IE and reducing complications.

Highlights

Complicated infective endocarditis (IE) with perivalvular abscess and destruction of the intervalvular fibrous body (IFB) has a high mortality risk and mostly requires emergent or urgent surgery
David et al [1] reported the technique of aortic valve replacement (AVR), mitral valve replacement (MVR) combined with reconstruction of the IFB, which is known as the Commando procedure
A high mortality rate and re-exploration for bleeding were noted in early series, which might be related to the emergent surgical procedure, fragile infected tissue, and difficulty of achieving hemostasis due to inaccessible posterior suture lines

Summary

Introduction

Complicated infective endocarditis (IE) with perivalvular abscess and destruction of the intervalvular fibrous body (IFB) has a high mortality risk and mostly requires emergent or urgent surgery. Patient 3 A 60-year-old man was admitted to our hospital for heart failure and intracardiac shunt (LVOT to left atrium) He had IE and left medial frontal cerebral infarction and undergone AVR at another hospital 2 weeks prior. Dehiscence of the aortic prosthetic valve with an annular abscess and vegetation over the aortic root to the mitral valve and one large perforation of the IFB were detected (Fig. 2e). The modified Commando procedure was performed, along with aortic root reconstruction with a metallic valve and gelatin vascular graft and the Cabrol method for coronary ostia reimplantation (Fig. 2f). Vegetation on the aortic noncoronary cusp, LVOT and IFB, an aortic annular abscess with perforation and mitral valve anterior leaflet perforation were detected. The postoperative course was smooth, except PPM implantation was performed for heart block

Discussion

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Conclusion