Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Eur J Cardiothorac Surg. 2023 Aug 1;64(2). doi: 10.1093/ejcts/ezad155.
The Commando technique for reconstruction of the aortomitral intervalvular fibrous body is effective to facilitate double valve surgery in cases of endocarditis or infiltrative calcification. The length of patch utilized in reconstruction of the intervalvular fibrous body has an important relationship to the geometry of the mitral valve (MV) and aortic valve (AV) and may impact on potential future valve-in-valve (VIV) therapy. Here we report anatomic measurements after Commando reconstruction in a small group of patients and analyse the impact of reconstruction techniques on transcatheter VIV therapies.
Seven patients from January 2018 to April 2022 who underwent double valve surgery with the Commando technique with postoperative computed tomography (CT) scans were identified. Computed tomographic reconstruction of the AV and MV was performed using 3mensio software and virtual transcatheter valve replacement was performed. Two of these patients who had preoperative imaging was analysed to assess the change in aortomitral geometry resulting from reconstruction.
Measurements for each patient post-reconstruction are given in the table. Aortomitral length was grossly inversely proportional to aortomitral angle (AMA). AMA and aortomitral curtain (AMC) length were significantly altered post-Commando in 2 analysed patients with pre- and postoperative computed tomography scan. Transcatheter AV and MV replacements were feasible in all patients post-Commando. The AMA was larger and more favorable for mitral VIV in patients in which the AMC was short.
AMC length, as determined by location of AV annular sutures, may be an important consideration in surgical decision-making for VIV after the Commando procedure.
重建房室瓣间隔纤维体的 Commando 技术对于在感染性心内膜炎或浸润性钙化的情况下进行双瓣手术是有效的。用于重建间隔纤维体的补片长度与二尖瓣 (MV) 和主动脉瓣 (AV) 的几何形状密切相关，可能会影响潜在的未来瓣中瓣 (VIV) 治疗。在此，我们报告了一小部分患者在 Commando 重建后的解剖学测量结果，并分析了重建技术对经导管 VIV 治疗的影响。
从 2018 年 1 月至 2022 年 4 月，我们共识别了 7 名接受 Commando 技术双瓣手术的患者，这些患者术后均进行了计算机断层扫描 (CT) 检查。使用 3mensio 软件对 AV 和 MV 进行 CT 重建，并进行虚拟经导管瓣膜置换。分析了其中 2 名术前有影像学检查的患者，以评估重建对房室瓣几何结构的影响。
表中给出了每位患者术后的测量值。主动脉瓣环长度与主动脉瓣环角度 (AMA) 呈大致反比关系。2 名接受术前和术后 CT 扫描的患者的 AMA 和主动脉瓣环幕长度在 Commando 手术后均发生了显著变化。所有患者在 Commando 手术后均可行经导管 AV 和 MV 置换。在 AMC 较短的患者中，AMA 更大，更有利于二尖瓣 VIV。
AV 瓣环缝线的位置决定 AMC 长度，这可能是 Commando 手术后 VIV 手术决策的一个重要考虑因素。
