Short to mid-term results of Chimney Commando in redo valve replacement: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Hongyan , HE Bihui , JIN Jing , SONG Laichun , FANG Jihui , ZHOU Xiang , CHEN Yan ,  TAO Liang

Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, 430022, P. R. China;

Corresponding author：

TAO Liang, Email: taoliangmd@163.com

Keywords：

Prosthesis-patient mismatch; double annulus enlargement; redo surgery

DOI：

10.7507/1007-4848.202312019

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the application of double valve ring enlargement combined with mitral Chimney technique (Chimney Commando) in the secondary valve replacement and to analyze the efficacy in the near and medium term. Methods Patients who underwent the secondary aortic valve and mitral valve (double valve) replacement by Chimney Commando in Wuhan Asia Heart Hospital from 2019 to 2022 were included, and their clinical data were retrospectively collected to analyze the safety and feasibility of this procedure in secondary valve replacement of small aortic root patients. Results A total of 49 patients (44 females and 5 males) were included. The body surface area was 1.64±0.17 m². The time from the first operation was 13.10±5.90 years. Except for 4 patients whose first operation was valvuloplasty, the remaining 45 patients were all patients after valve replacement, 41 patients of double valves replacement, including 39 patients with mechanical valve and 2 patients with biological valve. The majority of the aortic valves were St.Jude regent 19 mm or St.Jude regent 21 mm, accounting for 30.61% and 34.69%, respectively. The mitral valves were predominantly St.Jude 25 mm mechanical valves, making up 65.31%. All patients underwent Chimney Commando double valve ring enlargement, and the mean time of aortic occlusion was 154.00±45.40 min. The mean size of the aortic valve was 23.90±1.40 mm and that of the mitral valve was 28.20±1.20 mm, and the transvalvular pressure difference across the aortic valve was 20.16±5.76 mm Hg at 6 months postoperatively. There was one death during hospitalization due to multi-organ failure. The follow-up time ranged from 1 to 24 months with a median time of 8 months. Two patients were implanted with permanent pacemakers during the follow-up period and 1 patient died due to massive stroke and malignant arrhythmia. Conclusion Chimney Commando is safe and effective in patients with secondary double valve replacement, and the postoperative prosthetic valves have good hemodynamics, and can achieve good clinical results in the near and medium term.

Citation： LIU Hongyan, HE Bihui, JIN Jing, SONG Laichun, FANG Jihui, ZHOU Xiang, CHEN Yan, TAO Liang. Short to mid-term results of Chimney Commando in redo valve replacement: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 860-866. doi: 10.7507/1007-4848.202312019 Copy

1.	Fallon JM, DeSimone JP, Brennan JM, et al. The incidence and consequence of prosthesis-patient mismatch after surgical aortic valve replacement. Ann Thorac Surg, 2018, 106(1): 14-22.
2.	Potter DD, Sundt TM, Zehr KJ, et al. Operative risk of reoperative aortic valve replacement. J Thorac Cardio vasc Surg, 2005, 129(1): 94-103.
3.	Luciani N, Nasso G, Anselmi A, et al. Repeat valvular operations: Bench optimization of conventional surgery. Ann Thorac Surg, 2006, 81: 1279-1283.
4.	Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19: 320-324.
5.	Park CB, Suri RM, Burkhart HM, et al. Identifying patients at particular risk of injury during repeat ster notomy: Analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5): 1028-1035.
6.	Jones JM, O'kane H, Gladstone DJ, et al. Repeat heart valve surgery: Risk factors for operative mortality. J Thorac Cardiovasc Surg, 2001, 122(5): 913-918.
7.	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, 2021, 164(5): 1474-1484.
8.	Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.
9.	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.
10.	Daniel F, Mustafa Z, Serban S. Aorto-mitral patch enlargement for elective eubstantial double valve upsizing. World J Pediatr Congen Heart Surg, 2020, 11(1): 101-104.
11.	Hani KN, Tara K, Munir A. Combined aortic and mitral annular enlargement with fibrous skeleton reconstruction. Ann Thorac Surg, 2021, 111(3): e177-e180.
12.	Atsuo M, Takashi W, Akihiko U, et al. Optimal size of prostheses for functioning of the aortic prosthetic valve in aortic and mitral valve replacement with annular enlargement through manouguian’s technique. Artif Organs, 2002, 26(1): 833-839.
13.	Yang M, Liu W, Song L, et al. Early outcomes of the "Chimney" commando procedure in the small aortic and mitral annuli. Front Cardiovasc Med, 2023, 10: 1139771.
14.	González Rocafort Á, Aroca Á, Polo L, et al. Chimney technique for mitral valve replacement in children. Ann Thorac Surg, 2013, 96(5): 1885-1887.
15.	Maeda T, Nagato H, Ishihara H. Early re-replacement after mitral valve replacement using the chimney technique in a child: A case report. Cardiol Young, 2023, 33(8): 1442-1444.
16.	Philippe P, Jean GD. Prosthetic heart valves: Selection of the optimal prosthesis and long-term management. Circulation, 2009, 119(7): 1034-1048.

1. Fallon JM, DeSimone JP, Brennan JM, et al. The incidence and consequence of prosthesis-patient mismatch after surgical aortic valve replacement. Ann Thorac Surg, 2018, 106(1): 14-22.
2. Potter DD, Sundt TM, Zehr KJ, et al. Operative risk of reoperative aortic valve replacement. J Thorac Cardio vasc Surg, 2005, 129(1): 94-103.
3. Luciani N, Nasso G, Anselmi A, et al. Repeat valvular operations: Bench optimization of conventional surgery. Ann Thorac Surg, 2006, 81: 1279-1283.
4. Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19: 320-324.
5. Park CB, Suri RM, Burkhart HM, et al. Identifying patients at particular risk of injury during repeat ster notomy: Analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg, 2010, 140(5): 1028-1035.
6. Jones JM, O'kane H, Gladstone DJ, et al. Repeat heart valve surgery: Risk factors for operative mortality. J Thorac Cardiovasc Surg, 2001, 122(5): 913-918.
7. 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, 2021, 164(5): 1474-1484.
8. Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.
9. 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.
10. Daniel F, Mustafa Z, Serban S. Aorto-mitral patch enlargement for elective eubstantial double valve upsizing. World J Pediatr Congen Heart Surg, 2020, 11(1): 101-104.
11. Hani KN, Tara K, Munir A. Combined aortic and mitral annular enlargement with fibrous skeleton reconstruction. Ann Thorac Surg, 2021, 111(3): e177-e180.
12. Atsuo M, Takashi W, Akihiko U, et al. Optimal size of prostheses for functioning of the aortic prosthetic valve in aortic and mitral valve replacement with annular enlargement through manouguian’s technique. Artif Organs, 2002, 26(1): 833-839.
13. Yang M, Liu W, Song L, et al. Early outcomes of the "Chimney" commando procedure in the small aortic and mitral annuli. Front Cardiovasc Med, 2023, 10: 1139771.
14. González Rocafort Á, Aroca Á, Polo L, et al. Chimney technique for mitral valve replacement in children. Ann Thorac Surg, 2013, 96(5): 1885-1887.
15. Maeda T, Nagato H, Ishihara H. Early re-replacement after mitral valve replacement using the chimney technique in a child: A case report. Cardiol Young, 2023, 33(8): 1442-1444.
16. Philippe P, Jean GD. Prosthetic heart valves: Selection of the optimal prosthesis and long-term management. Circulation, 2009, 119(7): 1034-1048.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short to mid-term results of Chimney Commando in redo valve replacement: A retrospective cohort study

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