Commando procedure in a patient with double-valve endocarditis after transcatheter aortic valve implantation

The indication for transcatheter aortic valve implantation (TAVI) is continuously expanding with a simultaneous increase in number of TAVI associated prosthetic valve endocarditis (TAVI–PVE). Evidence for management of TAVI–PVE is lacking but the need for surgical management of complex TAVI–PVE is expected to increase. The Commando procedure, a technically challenging surgery for treatment of complex endocarditis, has never been described in a patient with TAVI–PVE. An 80-year-old female with TAVI–PVE, native mitral valve endocarditis and an abscess in the intervalvular fibrous body was admitted to our clinic. She successfully underwent the Commando procedure with implantation of biological mitral and aortic valve prostheses and reconstruction of the intervalvular fibrous body. We demonstrate that the Commando procedure is a feasible surgical alternative in patients with TAVI–PVE and that it can be considered in patients with high surgical risk.