Reconstruction of the Left Ventricular Outflow Tract in Patients with Destruction of the Intervalvular Fibrosa, the “Commando Operation”

Double Valve Infective Endocarditis (IE) with destruction of the intervalvular fibrosa (IVF) connecting the anterior mitral leaflet and the aortic valve is a familiar pathology to surgeons experienced with IE, particularly in patients with prosthetic valves in one or both positions. The term “commando operation” was coined by Lytle at the Cleveland Clinic in the 1990s to name the operation that included aortic and mitral valve replacement together with reconstruction of the IVF. This operation requires an experienced valve surgeon with deep understanding of anatomy and endocarditis pathology.