Mid-term outcomes of intervalvular fibrosa body reconstruction with Commando variants for active infective endocarditis.

Objectives: Infective endocarditis with intervalvular fibrosa involvement is a life-threatening condition. Fibrous skeleton reconstructive options encompass variants of the 'Commando' operation dictated by surgical findings. We aim to review the characteristics and outcomes of patients undergoing different iterations of this operation.

Methods: Retrospective analysis of patients who underwent intervalvular fibrosa reconstruction in the setting of acute infective endocarditis at 2 national referral centres from April 2014 to November 2023. Patients were divided into 2 groups, regarding the extent of surgery at the aortic root level: non-ROOT ('Commando') and ROOT (Root-'Commando': commando with root replacement).

Results: Seventy-eight patients were included; 30 (38.5%) in the ROOT group and 48 (61.5%) the non-ROOT group. There were no differences in perioperative mortality, postoperative complications and follow-up reoperations or reinfections. There were no relapses in both groups. Median follow-up was 4.69 years (95% CI 3.10-5.13). Overall, in-hospital and/or 30-day mortality was 14 (17.9%), without differences between groups. Overall survival rates at 1 and 5 years were 76.2% and 67.2%, respectively. Overall survival was 74%, 74% and 68% in the non-ROOT group and 79%, 79% and 63% in the ROOT group, respectively, at 1, 2 and 5 years.

Conclusions: Variants of the 'Commando' operation offer stable cardiac fibrous skeleton reconstructions to patients without alternative repair options. Provided that surgical reconstruction is achieved, there are no differences in early and mid-term outcomes based on the use of root replacement. Absence of relapses can be achieved with these techniques.