Commando Surgery: Everything You Need to Know About This Complex Cardiac Procedure

You’ve probably never heard the term “commando surgery” unless you or someone close to you has been through some serious health situation. It's not something you just stumble upon, like a cold remedy or toothache advice. This is heavy-duty medical stuff — the kind of operation that could easily be mistaken for something military-related because, honestly, it sounds like it. But no, it’s not about soldiers or combat missions. This is a type of high-risk, life-saving surgery done in cases where there’s really no other option.

In India, where cardiac disease rates are rising fast, awareness of complex surgical options like this is more important than ever. Whether you're a patient looking for clarity, a worried family member, or just plain curious, this guide breaks down everything you need to know — from what it is, to how much it costs, and what to expect before and after.

Let’s start at the beginning.

What Is Commando Surgery?

Commando surgery is a radical surgical procedure that's usually performed in two different scenarios — for treating aggressive head and neck cancers, and in the cardiac world, for tackling severe, complex heart disease. While the name is shared between the two, the approach and anatomy involved are quite different.

In the cardiac context, commando surgery involves replacing multiple heart valves, often the aortic and mitral valves, and repairing or removing infected or damaged tissue. Sometimes, this is done in combination with coronary artery bypass grafting (CABG) — making it one of the most challenging surgeries in cardiac care.

The term “commando” itself doesn’t come from the military — not exactly. It originated from the fact that this type of surgery requires aggressive, all-in-one interventions, kind of like a full-force assault against disease. Hence the name stuck.

Now, that might sound a little dramatic (and honestly, it is), but when you’re dealing with infected prosthetic valves, multiple valve failures, or even life-threatening endocarditis, this type of extreme action is necessary.

Types of Commando Surgery Procedures

Head and Neck Commando Surgery

This version is more commonly known in oncology departments. It’s performed when cancers in the oral cavity, pharynx, or jawline have spread significantly. Surgeons remove the tumor, nearby tissues, lymph nodes, and sometimes part of the jaw or tongue — a real tough one, both physically and emotionally for the patient.

While that’s outside the scope of this article (we're focusing on cardiac), it's useful to know there are two meanings.

Commando Cardiac Surgery

This is where things get really intricate. In India, a growing number of patients with rheumatic heart disease, valve infections, or prosthetic valve complications are being recommended for this approach. It’s no “routine bypass” — it requires a team of senior surgeons, skilled anesthetists, and post-op critical care.

You might be wondering — why not just fix one valve at a time? Well, in many cases, the damage is so widespread that treating just one valve would leave the others failing. A partial fix simply doesn’t work. The whole “commando” idea is to go in, fix everything in one go, and get out. Not easy, not cheap, but often life-saving.

The Commando Cardiac Surgery Procedure Explained

So, what actually happens during a commando cardiac surgery? To put it simply — a lot. This isn't your average three-hour procedure. We're talking about a 6 to 10-hour marathon in the operating room, sometimes more if complications arise (which, unfortuantely, they often do).

First, the patient is placed under general anesthesia and connected to a cardiopulmonary bypass machine — this machine takes over the work of the heart and lungs during surgery. The chest is then opened via median sternotomy (a fancy term for splitting the breastbone), and the heart is carefully accessed.

From here, the surgeons will:

• Remove damaged or infected aortic and mitral valves

• Clean out any abscesses or infected tissue

• Reconstruct parts of the heart septum or valve annuli using grafts or patches

• Replace the valves with mechanical or tissue prosthetics

• If needed, perform coronary artery bypass grafting at the same time

Sounds intense? That’s because it is. The heart, already fragile, is being operated on while it's not even beating. Every move must be precise. Even a small mistake (and they do happen, sadly) can lead to bleeding, stroke, or worse.

What Structures Are Removed in Commando Surgery?

Now this is a question a lot of patients ask, sometimes nervously. “Are you taking out my whole heart?” The answer is no. But — large, critical components are removed, especially if there’s infection.

In most cases, the aortic valve, mitral valve, and the fibrous tissue that connects them (called the intervalvular fibrosa) are removed. If infection has spread, then abscess cavities or necrotic tissue surrounding these valves are also excised. This may also involve partial removal of the atrial septum, or even parts of the aortic root.

It’s like doing a deep clean and a renovation at the same time. Remove what's broken. Fix the structure. Replace with strong parts.

One Indian surgeon once described it like this: "Imagine replacing the hinges and lock system on a door while also rebuilding the wall it’s attached to — all while keeping the house from collapsing." That’s commando cardiac surgery in a nutshell.

When Is Commando Surgery Recommended?

This isn’t a surgery doctors suggest lightly. It’s typically reserved for:

• Prosthetic valve endocarditis (a serious infection of a previously replaced valve)

• Severe multivalve disease where both aortic and mitral valves are failing

• Recurrent valve dysfunctions after earlier surgeries

• Infective endocarditis with abscess formation

• Patients who’ve had previous cardiac surgeries and now require another major intervention

These conditions are life-threatening and often progress quickly. In many cases, the patient might not even know how bad things have gotten until they’re rushed to a tertiary hospital with breathing issues, chest pain, or even organ failure.

It’s not a choice. It’s a necessity.

Commando Surgery in India

India, being a medical tourism hub and home to some of the world’s top cardiac specialists, has steadily built capacity for performing advanced procedures like commando cardiac surgery. While not every hospital offers it — due to the surgical expertise and infrastructure required — there are several renowned centers where this complex operation is performed successfully.

Top Hospitals Offering Commando Surgery in India

Some leading hospitals where patients may undergo this procedure include:

• AIIMS, New Delhi

• Apollo Hospitals (multiple cities)

• Narayana Health (Bangalore)

• Fortis Escorts Heart Institute, Delhi

• Amrita Institute of Medical Sciences, Kochi

These centers have teams experienced in redo cardiac surgeries, high-risk valve replacements, and infective endocarditis management — key skills needed for a successful commando procedure.

What Is the Cost of Commando Surgery in India?

Now comes the big question: how much does it cost?

The price of a commando surgery in India can range anywhere between ₹5.5 lakhs to ₹12 lakhs, depending on the hospital, city, complexity of the case, and duration of ICU/hospital stay. In government institutions like AIIMS or PGIMER, it may be significantly cheaper — around ₹2-3 lakhs — though wait times are longer.

What’s Included in the Cost?

• Pre-surgical diagnostics (ECG, echocardiogram, blood work)

• Operation theatre charges

• Surgeon’s fee

• Heart-lung machine & bypass supplies

• ICU and ward care (7–15 days typically)

• Medications and post-op rehabilitation

Do remember though — unexpected complications can stretch the bill quite a bit, especially in private setups.

Insurance and Government Assistance

Most private health insurance plans in India do cover commando surgery if it’s medically indicated and not elective. That said, it’s always a good idea to check exclusions related to congenital conditions or valve replacements.

For those under government schemes like Ayushman Bharat (PM-JAY) or state-level health cards, some public hospitals offer full or partial coverage. It's a godsend for lower-income families.

Just a heads-up: Paperwork is a pain point. Often, patients end up running pillar to post while also dealing with medical crises. Not ideal — but it’s slowly improving.

Frequently Asked Questions (FAQs)

What is the commando surgery?

It’s a complex surgery involving removal and replacement of two or more heart valves, usually done when severe infection or damage makes simpler surgeries ineffective.

What is commando cardiac surgery?

This is the cardiac version of commando surgery, targeting the aortic and mitral valves — often replacing both and reconstructing connecting tissue.

What structure is removed in commando surgery?

Valves, infected heart tissue, fibrous tissue between valves, and sometimes parts of the atrial septum or aortic root are removed.

What is the cost of commando surgery?

It ranges from ₹5.5 to ₹12 lakhs in private hospitals. Government hospitals may offer it for less, especially under subsidy or insurance.

Final Thoughts

Commando cardiac surgery isn't just a medical term. For many patients in India, it's a lifesaver — the last, best shot at fixing a failing heart.

Yes, it’s high-risk.
Yes, it’s expensive.
And yes — it’s scary as hell.

But when performed at the right center, by the right team, under the right conditions — it can give people a second chance at life. And that's something worth talking about.

If someone you love is facing this procedure, don’t panic. Get informed, get multiple opinions, and trust the process. It’s not easy, but recovery is real — and so is hope.