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Introduction <p>Commando surgery carries a substantial risk of bleeding owing to its multiple operative steps, prolonged cardiac arrest time, and the need for many sutures to the fragile tissues of the heart. Prosthetic valve infective endocarditis, especially after multiple valve replacements, can be difficult to treat surgically because of the high degree of adhesions.</p> Case Presentation <p>We report a 66-year-old man who underwent a Commando procedure for recurrent prosthetic valve endocarditis, following two previous double valve replacement surgeries. Adequate exposure was achieved without injury to surrounding structures by selecting an incision line that avoided extensive dissection of dense adhesions. Bleeding was further minimized by reconstructing the aortic, left atrial, and right atrial walls while preserving adherent tissue as much as possible.</p> Conclusion <p>The route of incision and reconstruction we have shown in this study may allows for reproducible Commando surgery even in the presence of strong adhesions.</p>

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A Safe Incision Line in Commando Surgery for Prosthetic Valve Infective Endocarditis with Dense Adhesions: A Case Report

  • 期刊论文

  • 发表日期：

    2026年4月25日

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  • Hiroaki Kaneyama,
  • Kiyoshi Koizumi,
  • Koki Ikebata,
  • Masayoshi Waga,
  • Kenichi Hashizume,
  • Hideyuki Shimizu

摘要

Introduction

Commando surgery carries a substantial risk of bleeding owing to its multiple operative steps, prolonged cardiac arrest time, and the need for many sutures to the fragile tissues of the heart. Prosthetic valve infective endocarditis, especially after multiple valve replacements, can be difficult to treat surgically because of the high degree of adhesions.

Case Presentation

We report a 66-year-old man who underwent a Commando procedure for recurrent prosthetic valve endocarditis, following two previous double valve replacement surgeries. Adequate exposure was achieved without injury to surrounding structures by selecting an incision line that avoided extensive dissection of dense adhesions. Bleeding was further minimized by reconstructing the aortic, left atrial, and right atrial walls while preserving adherent tissue as much as possible.

Conclusion

The route of incision and reconstruction we have shown in this study may allows for reproducible Commando surgery even in the presence of strong adhesions.