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. 2023 Mar 22:19:104-108.
doi: 10.1016/j.xjtc.2023.03.008. eCollection 2023 Jun.

The Commando procedure for pediatric patients: A case series

Hiroo Kinami  1 , David M Kalfa  1 , Andrew B Goldstone  1 , Mattan I Setton  2 , Anne Marie Ferris  2 , Emile A Bacha  1
Affiliations

The Commando procedure for pediatric patients: A case series

Hiroo Kinami et al. JTCVS Tech. .

Abstract

Objective: The Commando procedure involves division of the intervalvular fibrous body, mitral valve replacement, and aortic valve replacement. It is considered a technically challenging procedure and traditionally has had high mortality.

Methods: Five pediatric patients with combined left ventricular inflow and outflow obstruction were included in this study.

Results: There were no early or late deaths during follow-up, and no pacemakers were implanted. None of the patients required reoperation during follow-up, and none developed a clinically significant gradient across the mitral valve or aortic valve.

Conclusions: The risks of this operation for patients with congenital heart disease undergoing multiple redo operations should be weighed against the benefits of normal-size mitral and aortic annular diameters and dramatically improved hemodynamics.

Keywords: Commando procedure; congenital cardiac surgery; multiple redo surgery; pediatric.

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Figures

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Graphical abstract
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The Commando procedure for pediatric patients undergoing multi-redo operations.
Figure 1
Figure 1
A, Right atrium–transseptal incision is joining the aortotomy at the dome of the LA. B, The previous AV and MV are removed carefully, and the aortomitral curtain is divided. C, The MV is implanted first, and then a single large oval-shaped bovine pericardial patch that is folded on itself is secured to the cut edges. The MV implantation is completed with approximately one-third of the mitral prosthesis secured on the patch. A few millimeters of the patch are left between the mitral and aortic prosthesis suture lines to avoid competition for each valve. D, The upper half of the patch is used to reconstruct the ascending aorta and the lower portion to reconstruct the roof of the LA. The atrial septum can be patched using another patch. SVC, Superior vena cava; Ao, aorta; PA, pulmonary artery; IVC, inferior vena cava; AoV, aortic valve; MV, mitral valve.
Figure 2
Figure 2
The Commando procedure can be performed safely and provides excellent early to midterm results for pediatric patients with combined AV and MV disease. LVOT, Left ventricular outflow tract; Ao, aorta; AoV, aortic valve; AV, aortic valve; MV, mitral valve; mPG, mean pressure gradient.
See this image and copyright information in PMC

References

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