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[Commando Procedure for Rapidly Progressing Infective Endocarditis in Immunosuppressive State: Report of a Case]

Yuka Sueta1, Toshiro Kobayashi, Sarii Tsubone

  • 1Departments of Surgery, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 22, 2023
PubMed

Insights

A complex heart infection caused by MRSA was treated with the Commando procedure. This surgery, involving valve replacement and aortic repair, proved effective for this critical cardiac condition.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • A 68-year-old immunocompromised patient developed infective endocarditis.
  • The infection was caused by methicillin-resistant Staphylococcus aureus (MRSA).

Observation:

  • Echocardiography revealed an aortic annular abscess with shunt flow into the left atrium, indicating intervalvular fibrosa (IVF) infection.
  • The patient experienced progressive heart failure, necessitating surgical intervention.

Findings:

  • The patient underwent a Commando procedure, including aortic valve and anterior mitral leaflet resection.
  • Mitral valve replacement with a bioprosthesis and reconstruction of the IVF and left atrial roof with a bovine pericardial patch were performed.
  • A Bentall procedure was necessary due to extension of infection to the sinus of Valsalva and aortic root dilation.

Implications:

  • The Commando procedure, despite high early mortality rates, can be an effective treatment for extensive MRSA infective endocarditis involving the aortic valve, IVF, and aortic root.
  • Successful surgical management in this case highlights the potential for complex cardiac reconstructions in critically ill patients.

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