Multiple valve endocarditis: a Hemi-Commando procedure

Invasive double valve endocarditis (aortic and mitral) involving the fibrous skeleton of the heart requires a complex high-risk surgical management. The procedure which was originally suggested by Tirone David, consists of double valve replacement with pericardial or Dacron patches to re-create “neoaortomitral continuity” (1). This operation was named by the Cleveland Clinic group a “Commando procedure”, the Leipzig group use the term “UFO procedure” (2). In patients in whom the posterior mitral leaflet is not affected by the infection and at least the free edge of anterior mitral could be spared, a modification of the Commando procedure was suggested and named the “Hemi-Commando procedure” (3).