Application of Commando and Hemi-Commando procedures in the reconstruction of intervalvular fibrous body_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Weiteng ¹ , QING Hongkun ² , CHEN Oudi ³ , GAN Lixi ¹ , CHEN Fanyu ² , LI Xin ² ,  JIAN Xuhua ²

1. Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, South Medical University, Guangzhou, 510010, P. R. China;
2. Department of Cardiac Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, South Medical University, Guangzhou, 510010, P. R. China;
3. Department of Echocardiography, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, South Medical University, Guangzhou, 510010, P. R. China;

Corresponding author：

JIAN Xuhua, Email: jianxuhua@gdph.org.cn

Keywords：

Commando procedure; Hemi-Commando procedure; intervalvular fibrous body reconstruction; invasive endocarditis

DOI：

10.7507/1007-4848.202211028

Video：

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Objective To analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). Methods The patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. Conclusion Commando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.

Citation： WANG Weiteng, QING Hongkun, CHEN Oudi, GAN Lixi, CHEN Fanyu, LI Xin, JIAN Xuhua. Application of Commando and Hemi-Commando procedures in the reconstruction of intervalvular fibrous body. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 991-999. doi: 10.7507/1007-4848.202211028 Copy

1.	张步升, 赵乃时, 杨天阳, 等. 再次双瓣膜置换联合主动脉幕帘重建术一例. 中国胸心血管外科临床杂志, 2019, 26(12): 1271-1272.
2.	Forteza A, Centeno J, Ospina V, et al. Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction. Ann Thorac Surg, 2015, 99(3): 838-845.
3.	Davierwala PM, Binner C, Subramanian S, et al. Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. Eur J Cardiothorac Surg, 2014, 45(1): 146-152.
4.	Navia JL, Al-Ruzzeh S, Gordon S, et al. The incorporated aortomitral homograft: A new surgical option for double valve endocarditis. J Thorac Cardiovasc Surg, 2010, 139(4): 1077-1081.
5.	Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30(4): 633-638.
6.	Navia JL, Elgharably H, Hakim AH, et al. Long-term outcomes of surgery for invasive valvular endocarditis involving the aortomitral fibrosa. Ann Thorac Surg, 2019, 108(5): 1314-1323.
7.	Elgharably H, Hakim AH, Unai S, et al. The incorporated aortomitral homograft for double-valve endocarditis: The 'hemi-Commando' procedure. Early and mid-term outcomes. Eur J Cardiothorac Surg, 2018, 53(5): 1055-1061.
8.	Davierwala PM, Marin-Cuartas M, Misfeld M, et al. Five-year outcomes following complex reconstructive surgery for infective endocarditis involving the intervalvular fibrous body. Eur J Cardiothorac Surg, 2020, 58(5): 1080-1087.
9.	David TE, Lafreniere-Roula M, David CM, et al. Outcomes of combined aortic and mitral valve replacement with reconstruction of the fibrous skeleton of the heart. J Thorac Cardiovasc Surg, 2022, 164(5): 1474-1484.
10.	Jiang X, Liu J, Khan F, et al. Aortic and mitral valve surgery for infective endocarditis with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes. J Thorac Dis, 2020, 12(4): 1427-1436.
11.	Giambuzzi I, Bonalumi G, Di Mauro M, et al. Surgical aortic mitral curtain replacement: Systematic review and metanalysis of early and long-term results. J Clin Med, 2021, 10(14): 3163.
12.	Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
13.	d'Udekem Y, David TE, Feindel CM, et al. Long-term results of operation for paravalvular abscess. Ann Thorac Surg, 1996, 62(1): 48-53.
14.	David TE, Feindel CM, Armstrong S, et al. Reconstruction of the mitral anulus. A ten-year experience. J Thorac Cardiovasc Surg, 1995, 110(5): 1323-1332.
15.	García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: Risk factors, outcome, and impact of cardiac surgery: A multicenter observational study. Circulation, 2013, 127(23): 2272-2284.
16.	Zeng X, Wu J, Li X, et al. Application of metagenomic next-generation sequencing in the etiological diagnosis of infective endocarditis during the perioperative period of cardiac surgery: A prospective cohort study. Front Cardiovasc Med, 2022, 9: 811492.

1. 张步升, 赵乃时, 杨天阳, 等. 再次双瓣膜置换联合主动脉幕帘重建术一例. 中国胸心血管外科临床杂志, 2019, 26(12): 1271-1272.
2. Forteza A, Centeno J, Ospina V, et al. Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction. Ann Thorac Surg, 2015, 99(3): 838-845.
3. Davierwala PM, Binner C, Subramanian S, et al. Double valve replacement and reconstruction of the intervalvular fibrous body in patients with active infective endocarditis. Eur J Cardiothorac Surg, 2014, 45(1): 146-152.
4. Navia JL, Al-Ruzzeh S, Gordon S, et al. The incorporated aortomitral homograft: A new surgical option for double valve endocarditis. J Thorac Cardiovasc Surg, 2010, 139(4): 1077-1081.
5. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis, 2000, 30(4): 633-638.
6. Navia JL, Elgharably H, Hakim AH, et al. Long-term outcomes of surgery for invasive valvular endocarditis involving the aortomitral fibrosa. Ann Thorac Surg, 2019, 108(5): 1314-1323.
7. Elgharably H, Hakim AH, Unai S, et al. The incorporated aortomitral homograft for double-valve endocarditis: The 'hemi-Commando' procedure. Early and mid-term outcomes. Eur J Cardiothorac Surg, 2018, 53(5): 1055-1061.
8. Davierwala PM, Marin-Cuartas M, Misfeld M, et al. Five-year outcomes following complex reconstructive surgery for infective endocarditis involving the intervalvular fibrous body. Eur J Cardiothorac Surg, 2020, 58(5): 1080-1087.
9. David TE, Lafreniere-Roula M, David CM, et al. Outcomes of combined aortic and mitral valve replacement with reconstruction of the fibrous skeleton of the heart. J Thorac Cardiovasc Surg, 2022, 164(5): 1474-1484.
10. Jiang X, Liu J, Khan F, et al. Aortic and mitral valve surgery for infective endocarditis with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes. J Thorac Dis, 2020, 12(4): 1427-1436.
11. Giambuzzi I, Bonalumi G, Di Mauro M, et al. Surgical aortic mitral curtain replacement: Systematic review and metanalysis of early and long-term results. J Clin Med, 2021, 10(14): 3163.
12. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
13. d'Udekem Y, David TE, Feindel CM, et al. Long-term results of operation for paravalvular abscess. Ann Thorac Surg, 1996, 62(1): 48-53.
14. David TE, Feindel CM, Armstrong S, et al. Reconstruction of the mitral anulus. A ten-year experience. J Thorac Cardiovasc Surg, 1995, 110(5): 1323-1332.
15. García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: Risk factors, outcome, and impact of cardiac surgery: A multicenter observational study. Circulation, 2013, 127(23): 2272-2284.
16. Zeng X, Wu J, Li X, et al. Application of metagenomic next-generation sequencing in the etiological diagnosis of infective endocarditis during the perioperative period of cardiac surgery: A prospective cohort study. Front Cardiovasc Med, 2022, 9: 811492.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Commando and Hemi-Commando procedures in the reconstruction of intervalvular fibrous body

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