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Updated: Jan 22, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Modified Commando operation using stentless aortic bioprosthesis.

Tetsuro Uchida1, Yoshinori Kuroda1, Azumi Hamasaki1

  • 1Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.

Journal of Cardiac Surgery
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Summary

Commando operations for extensive endocarditis require aortic root replacement. A modified approach using supra-annular aortic valve replacement simplifies this complex cardiac surgery.

Keywords:
valve repair/replacement

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Area of Science:

  • Cardiac Surgery
  • Cardiovascular Research
  • Bioprosthetic Valves

Background:

  • Commando operations involve intervalvular fibrous body reconstruction for extensive endocarditis.
  • Traditional Commando operations often necessitate aortic root replacement due to extensive aortic annular defects.
  • Radical debridement is a critical step in managing these complex cases.

Observation:

  • A modified Commando operation was performed, utilizing supra-annular aortic valve replacement.
  • The Solo Smart stentless bioprosthesis was employed in this modified procedure.
  • This approach aimed to avoid traditional aortic root replacement.

Findings:

  • Supra-annular implantation of the bioprosthesis spares damaged annular structures.
  • The modified technique simplifies the technical demands of the reconstructive surgery.
  • This method offers an alternative to standard aortic root replacement.

Implications:

  • This modification may reduce the complexity and invasiveness of Commando operations.
  • It provides a potentially less demanding surgical option for patients with extensive endocarditis.
  • Further research can explore long-term outcomes and broader applicability of this technique.