Commando Procedure For Complex Patients
Burak Ersoy, Burak Onan, Zinar Apaydın, Abdulkerim Bugra, Zihni Mert Duman.
Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey.
BACKGROUND: Patients with small aortic root, who will undergo both aortic and mitral valve replacement, the surgical technique is important. We would like to share our experience about Commando procedure and its early results.
METHOD: Operations were performed between February 2021-September 2022 at Istanbul Mehmet Akif Ersoy Thoracic and Cardivascular Surgery Hospital by the same surgical team. 11 patients were operated. Patient and operation details are summarized in Table 1. All patients share same pathology; small aortic root. An oblique aortotomy was performed and the native/previously replaced aortic valve was excised. The aortotomy was enlarged through the noncoronary aortic sinus and aortic annulus until reaching the intervalvular fibrous body. The dome of the left atrium was opened. The mitral valve and the intervalvular fibrous body were radically excised. Mitral valve replacement was performed with ventricular pledgeted sutures of 2-0 polyester. A triangular single-folded glutaraldehyde fixed bovine pericardium was used to reconstruct the intertrigonal mitral aortic junction. The patch was secured laterally to the lateral and medial fibrous trigones with a continuous 4-0 polypropylene suture. After closure of the dome of the left atrium, we proceeded to suture the inner patch to the margins of the aortic wall, forming the new subaortic curtain and the posterior segment of the left ventricular outflow tract. A prosthetic aortic valve was secured to the aortic annulus and to the pericardial patch. The remaining inner half patch was used to close the right side of the aortotomy.
RESULTS: There was no mortality. The median ICU duration and median hospital stay were 3.45(2-8) and 10.6(5-19) days respectively. Postoperative echocardiography revealed both aortic and mitral valves were in normal function and gradient values were within normal ranges.
CONCLUSION: The Commando technique plays an important role in patients with history of previous cardiac surgery, infective endocarditis with narrow aortic root and in the need of aortic and mitral valve replacement. In these patients; Commando procedure allows valve replacement with appropriate size and prevents patient-prosthesis mismatch. We believe that Commando procedure is an important surgical method that can be preferred in such complex patients that conventional surgery cannot solve.
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