Modified commando operation using stentless aortic bioprosthesis in patient with severe aortic annular destruction owing to massive infective endocarditis.

Aortic root  replacement and mitral valve replacement in combination with intervalvular fibrous body reconstruction are referred to as "commando operations," an indicator of the procedure's challenge. Aortic root reconstruction is inevitable in patients with active infective endocarditis when performing the commando operation for extensive aortic annular defect after radical débridement.  In this video tutorial, we demonstrate a modified commando operation, in which supra-annular aortic valve replacement with the Solo Smart stentless bioprosthesis was employed instead of aortic root replacement. The unique supra-annular implantation technique of the Solo Smart valve does not require manipulation of the damaged and inflamed annular structure. We named this modification as the "Solo-commando operation". Even considering the need for partial aortic wall reconstruction, the Solo-commando operation is simpler than the "standard" commando operation, which includes aortic root and mitral valve replacement.