Mona Kakavand MD , Filip Stembal MD , Lin Chen BA , Rashed Mahboubi MD , Habib Layoun MD , Serge C. Harb MD , Fei Xiang MD , Haytham Elgharably MD , Edward G. Soltesz MD , Faisal G. Bakaeen MD , Kevin Hodges MD , Patrick R. Vargo MD , Jeevanantham Rajeswaran PhD , Austin Firth MS , Eugene H. Blackstone MD , Marc Gillinov MD , Eric E. Roselli MD , Lars G. Svensson MD, PhD , Gösta B. Pettersson MD, PhD , Shinya Unai MD , Douglas R. Johnston MD
{"title":"Contemporary experience with the Commando procedure for anterior mitral anular calcification","authors":"Mona Kakavand MD , Filip Stembal MD , Lin Chen BA , Rashed Mahboubi MD , Habib Layoun MD , Serge C. Harb MD , Fei Xiang MD , Haytham Elgharably MD , Edward G. Soltesz MD , Faisal G. Bakaeen MD , Kevin Hodges MD , Patrick R. Vargo MD , Jeevanantham Rajeswaran PhD , Austin Firth MS , Eugene H. Blackstone MD , Marc Gillinov MD , Eric E. Roselli MD , Lars G. Svensson MD, PhD , Gösta B. Pettersson MD, PhD , Shinya Unai MD , Douglas R. Johnston MD","doi":"10.1016/j.xjon.2023.10.038","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.</p></div><div><h3>Methods</h3><p>From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs).</p></div><div><h3>Results</h3><p>Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, <em>P</em> = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, <em>P</em> = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, <em>P</em> = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% (<em>P</em> = .33) and 87% versus 100% (<em>P</em> = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, <em>P</em> = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively (<em>P</em> = .47).</p></div><div><h3>Conclusions</h3><p>The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273623003698/pdfft?md5=44a615e4dd813ed1d87a45b7bec54611&pid=1-s2.0-S2666273623003698-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273623003698","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements.
Methods
From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs).
Results
Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, P = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, P = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, P = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% (P = .33) and 87% versus 100% (P = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, P = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively (P = .47).
Conclusions
The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
