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How I Do It: The Hemi-Commando Procedure
Lloyd McPherson Felmly, MD, Minoo N. Kavarana, MD.
Medical University of South Carolina, Charleston, SC, USA.

Objective(s): Invasive multi-valve infectious endocarditis (IE) remains difficult to treat with high mortality rates. Adequate surgical debridement of invasive endocarditis often necessitates complex reconstruction. A 20-year old male with congenital aortic stenosis presented with stroke and IE of the aortic valve and multiple pseudoaneurysms involving the aortic root and intervalvular fibrosa.
Methods: The patient was treated with aggressive surgical debridement and "Hemi-Commando," or incorporated aortomitral homograft, reconstruction to replace the aortic valve and intervalvular fibrosa, as well as repair the mitral valve.
Results: The patient has enjoyed good short- and mid-term outcome. He is currently 4 years from surgery and doing well at last follow-up.
Conclusions: Surgical techniques involving radical debridement and reconstruction, such as the Hemi-Commando procedure, demonstrate acceptable outcomes for the treatment of invasive multi-valve IE. The Hemi-Commando is a complicated operation requiring specialized expertise, but all practicing cardiac surgeons should be familiar with its indications and applications.


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