Repair of concomitant aortic and mitral valvular disease with involvement of the aortomitral
curtain requires a technically complex operation colloquially termed the commando
procedure. Surgical outcomes of this procedure are not well described. The objective
of this study was to examine outcomes of the commando procedure at our center. We
identified all patients undergoing concomitant aortic and mitral valve replacements
from 2004–2021. Of 363 patients, 41 underwent reconstruction of the aortomitral curtain.
Survival analysis and multivariable modeling were used to examine outcomes and risk
factors for mortality. The median age was 52 (IQR 44-71) years. Preoperatively, 4
of 41 (9.8%) patients had renal failure, and 10 of 41 (24.4%) had a stroke. The most
common surgical indication was endocarditis in 25 of 41 (61.0%) patients. 25 of 41
(61.0%) patients underwent redo sternotomy, and 23 of 41 (56.1%) had previous prosthetic
valves. Operative mortality was 14 of 41 (34.1%), and 8 of 41 (9.5%) patients received
a permanent pacemaker. Survival at 1, 3, and 5 years was 55.4% (95% confidence interval
(CI), 40.6–75.5%), 50.3% (35.0–72.3%), and 37.7% (19.3–73.9%) respectively. Cox proportional
hazards regression identified previous sternotomy (HR 4.76, 95% CI 1.21–18.73), and
female gender (HR 1.39, 95% CI 1.17–13.82) as risk factors for mortality. Patients
undergoing reconstruction of the aortomitral curtain represent a high-risk population
with complex surgical indications. Due to high perioperative morbidity and mortality,
this procedure should be performed only when necessary. Despite a high up front morbidity
burden, outcomes remain favorable for patients who survive the initial hospitalization.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
CI (Confidence Interval), HR (Hazard Ratio), IQR (Interquartile Range), LVEF (Left Ventricular Ejection Fraction), NYHA (New York Heart Association), OR (Odds Ratio), SAVR (Surgical Aortic Valve Replacement), SD (Standard Deviation), STS (Society of Thoracic Surgeons), TAVR (Transcatheter Aortic Valve Replacement), TEE (Transesophageal Echocardiogram), TTE (Transthoracic Echocardiogram)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 05, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This work was funded by the Department of Surgery, Keck School of Medicine
Conflict of Interest: The authors have no conflicts of interest or financial disclosures
This work was presented at the 48th Annual Meeting of the Western Thoracic Surgical Association on June 24th, 2022 in Koloa, Hawaii
Read at the 48th Annual Meeting of the Western Thoracic Surgical Association, June 22 - 25, 2022, Koloa, Hawaii
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