Clinical application of Commando procedure in reoperation for mechanical valve dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Bo , FAN Ting ,  CAO Yong , YU Guanshui , HU Lian , ZHU Ren

Department of Cardiovascular Surgery, Gaozhou People's Hospital, Gaozhou, 525200, Guangdong, P. R. China;

Corresponding author：

CAO Yong, Email: wildness@163.com

Keywords：

Commando procedure; mechanical valve dysfunction; re-valve replacement

DOI：

10.7507/1007-4848.202212026

Video：

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Objective To explore the feasibility and effectiveness of Commando procedure for mechanical valve dysfunction requiring reoperation. Methods The clinical data of patients who received Commando surgery (aortic/mitral curtain enlargement+valve replacement surgery) in the Department of Cardiovascular Surgery of Gaozhou People's Hospital from December 2021 to September 2022 were retrospectively analyzed. These patients who had undergone mechanical mitral or aortic valve replacement and then had mechanical valve dysfunction with mitral or aortic valve lesions requiring repeat combined valve replacement surgery were selected. Results Eleven patients were enrolled, including 2 males and 9 females, aged 63.63±11.64 years. All 11 patients successfully underwent the Commando operation, and were implanted with suitable artificial valves, among which the aortic valve size was 27.00±2.00 mm, and the mitral valve size was 27.72±3.13 mm. Cardiopulmonary bypass time was 195.81±39.29 min, aortic cross-clamping time was 121.81±28.60 min, mechanical ventilation time was 15.09±3.72 h, ICU stay time was 3.09±0.70 days, and total postoperative thoracic drainage volume was 417.18±68.65 mL. There was no perioperative death. Conclusion Commando procedure is a safe and effective method to perform combined valve operation for mechanical valve dysfunction. A larger artificial valve can be implanted during the procedure to obtain sound hemodynamic effects. In addition, for elderly patients, a suitable type of bioprosthetic valve can be implanted to improve the patient's quality of life. The early surgical effect is satisfactory, and the long-term impact needs further follow-up.

Citation： CHEN Bo, FAN Ting, CAO Yong, YU Guanshui, HU Lian, ZHU Ren. Clinical application of Commando procedure in reoperation for mechanical valve dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 838-841. doi: 10.7507/1007-4848.202212026 Copy

1.	Kalkan S, Güner A, Kalçık M, et al. Lessons learned from intermittent dysfunction of mechanical heart valve. Anatol J Cardiol, 2022, 26(9): 725-732.
2.	Yu J, Wang W. Bioprosthetic vs. mechanical mitral valve replacement for rheumatic heart disease in patients aged 50-70 years. Front Cardiovasc Med, 2022, 9: 904958.
3.	Coutinho GF, Martínez Cereijo JM, Correia PM, et al. Long-term results after concomitant mitral and aortic valve surgery: Repair or replacement? Eur J Cardiothorac Surg, 2018, 54(6): 1085-1092.
4.	David TE, Kuo J, Armstrong S. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body. J Thorac Cardiovasc Surg, 1997, 114(5): 766-771.
5.	Misfeld M, Davierwala PM, Borger MA, et al. The "UFO" procedure. Ann Cardiothorac Surg, 2019, 8(6): 691-698.
6.	Testa L, Casenghi M, Criscione E, et al. Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: The TRANSIT-PPM international project. Front Cardiovasc Med, 2022, 9: 931207.
7.	Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart, 2019, 105(Suppl 2): s28-s33.
8.	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.
9.	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.
10.	De Oliveira NC, David TE, Armstrong S, et al. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes. J Thorac Cardiovasc Surg, 2005, 129(2): 286-290.
11.	Chen P, Chang C, Chuang Y, et al. Modified commando procedure in complicated infective endocarditis─A case series. J Cardiothorac Surg, 2021, 16(1): 79.
12.	Ugurlucan M, Oztas DM, Turkoglu H. The Commando procedure: Can it be a preventive option from reoperation in pediatric patients? J Card Surg, 2021, 36(3): 1144-1147.
13.	Elde S, de Biasi A, Woo YJ, et al. A novel alternative to the Commando procedure: Constructing a neo-aortic root by anchoring to the sewing ring of the replaced mitral valve. JTCVS Tech, 2020, 4: 101-102.
14.	Vojacek J, Zacek P, Ondrasek J. Multiple valve endocarditis: A hemi-Commando procedure. Ann Cardiothorac Surg, 2019, 8(6): 705-707.
15.	Perri JL, Johnston DR. Commando procedure in a radiated chest. JTCVS Tech, 2022, 15: 54-57.
16.	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.
17.	Kim GS, Kim JB, Han S, et al. Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement. Interact Cardiovasc Thorac Surg, 2014, 18(1): 73-79.
18.	Li J, Wang S, Sun H, et al. Clinical and surgical evaluations of reoperation after mechanical mitral valve replacement due to different etiologies. Front Cardiovasc Med, 2022, 8: 778750.

1. Kalkan S, Güner A, Kalçık M, et al. Lessons learned from intermittent dysfunction of mechanical heart valve. Anatol J Cardiol, 2022, 26(9): 725-732.
2. Yu J, Wang W. Bioprosthetic vs. mechanical mitral valve replacement for rheumatic heart disease in patients aged 50-70 years. Front Cardiovasc Med, 2022, 9: 904958.
3. Coutinho GF, Martínez Cereijo JM, Correia PM, et al. Long-term results after concomitant mitral and aortic valve surgery: Repair or replacement? Eur J Cardiothorac Surg, 2018, 54(6): 1085-1092.
4. David TE, Kuo J, Armstrong S. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body. J Thorac Cardiovasc Surg, 1997, 114(5): 766-771.
5. Misfeld M, Davierwala PM, Borger MA, et al. The "UFO" procedure. Ann Cardiothorac Surg, 2019, 8(6): 691-698.
6. Testa L, Casenghi M, Criscione E, et al. Prosthesis-patient mismatch following transcatheter aortic valve replacement for degenerated transcatheter aortic valves: The TRANSIT-PPM international project. Front Cardiovasc Med, 2022, 9: 931207.
7. Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart, 2019, 105(Suppl 2): s28-s33.
8. 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.
9. 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.
10. De Oliveira NC, David TE, Armstrong S, et al. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: An analysis of clinical outcomes. J Thorac Cardiovasc Surg, 2005, 129(2): 286-290.
11. Chen P, Chang C, Chuang Y, et al. Modified commando procedure in complicated infective endocarditis─A case series. J Cardiothorac Surg, 2021, 16(1): 79.
12. Ugurlucan M, Oztas DM, Turkoglu H. The Commando procedure: Can it be a preventive option from reoperation in pediatric patients? J Card Surg, 2021, 36(3): 1144-1147.
13. Elde S, de Biasi A, Woo YJ, et al. A novel alternative to the Commando procedure: Constructing a neo-aortic root by anchoring to the sewing ring of the replaced mitral valve. JTCVS Tech, 2020, 4: 101-102.
14. Vojacek J, Zacek P, Ondrasek J. Multiple valve endocarditis: A hemi-Commando procedure. Ann Cardiothorac Surg, 2019, 8(6): 705-707.
15. Perri JL, Johnston DR. Commando procedure in a radiated chest. JTCVS Tech, 2022, 15: 54-57.
16. 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.
17. Kim GS, Kim JB, Han S, et al. Mitral valve repair versus replacement for moderate-to-severe mitral regurgitation in patients undergoing concomitant aortic valve replacement. Interact Cardiovasc Thorac Surg, 2014, 18(1): 73-79.
18. Li J, Wang S, Sun H, et al. Clinical and surgical evaluations of reoperation after mechanical mitral valve replacement due to different etiologies. Front Cardiovasc Med, 2022, 8: 778750.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of Commando procedure in reoperation for mechanical valve dysfunction

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