Successful Commando procedure using the superior transseptal approach in a high-risk case

Area of Science:

• Cardiac Surgery
• Cardiovascular Medicine
• Surgical Techniques

Background:

• The Commando procedure, involving aortic and mitral valve replacement with intervalvular fibrous body reconstruction, is complex.
• Standard surgical access may be limited by extensive adhesions from prior cardiac surgeries.
• A superior transseptal incision can improve operative exposure and minimize surrounding tissue damage.

Purpose of the Study:

• To evaluate the efficacy of a superior transseptal approach for the Commando procedure.
• To demonstrate a modified surgical technique for complex valve replacement cases.

Main Methods:

• A 48-year-old female patient with multiple comorbidities underwent the Commando procedure.
• Severe aortic and mitral stenosis were addressed using a superior transseptal approach.
• Aortic and mitral valves were replaced with 25-mm INSPIRIS and 25-mm MITRIS prostheses, respectively.
• Intervalvular fibrous body reconstruction was performed using a bovine pericardium patch.

Main Results:

• The superior transseptal approach provided excellent surgical exposure.
• A stable operative field was maintained throughout the complex procedure.
• The patient recovered without major complications.

Conclusions:

• The superior transseptal approach is a valuable modification for the Commando procedure.
• This technique facilitates standardized surgical maneuvers in patients with extensive adhesions.
• It improves safety and efficacy in complex aortic and mitral valve replacement surgeries.