Yang Mingyuan, Liu Wenhao, Song Laichun, Wu Jingcheng, Xiao Yong, Liu Yuhang, Tao Liang
Department of Cardiac Surgery, Asia Heart Hospital of Wuhan University, Wuhan, China.
Front Cardiovasc Med. 2023 Jul 24;10:1139771. doi: 10.3389/fcvm.2023.1139771. eCollection 2023.
Commando procedure, the surgical replacement of the mitral and aortic valves combined with reconstruction of the fibrosa fibrous body, is a technical challenge in patients with small aortic and mitral annuli. In this study, we evaluated the safety and early outcomes of the "Chimney" modality of the Commando procedure, in patients with small aortic and mitral annuli, after prior valve surgery, using a self-assembled valved conduit.
From April 2021 to April 2022, 30 consecutive cases of the "Chimney" Commando procedure, with a self-assembled valved conduit and other combined cardiac procedures, were fully performed for re-operative patients with small aortic roots. Data were obtained through a medical record review, at the Asian Heart Hospital in Wuhan, China.
The patient's mean age was 52.7 ± 13.53 years, with 93.3% females. All patients had a previous heart valve surgery, 90% of which had double valve replacement (DVR). Hospital death occurred in 3.3% ( = 1) of the patients, due to malignant arrhythmias and multiorgan failure. Postoperative echocardiogram exams showed that the sizes of the aortic and mitral valve prostheses were 24.23 ± 1.60 mm and 28.33 ± 1.21 mm, respectively. All patients had intact intervalvular fibrosa (IVF) repair and no patient had any aberration in the left heart chamber communication. With the exception of one postoperative sick sinus syndrome and one re-sternotomy for bleeding, there were no significant postoperative complications, such as mortality, renal failure requiring ongoing dialysis, or mediastinitis. Echocardiography exams in the sixth postoperative month showed that the mean gradients of the aortic and mitral valves were 16.26 ± 6.44 mmHg and 11.24 ± 4.90 mmHg, respectively.
In comparison with the standard Commando operation, the early outcomes and safety of the "Chimney" Commando procedure proved to be a feasible therapeutic option for patients with small aortic and mitral annuli, after prior valve operations. This approach enables the enlargement of the aortic and mitral annuli and the implantation of the necessary valve prosthesis.
“突击”手术，即二尖瓣和主动脉瓣置换术联合纤维体纤维重建术，对于主动脉瓣和二尖瓣瓣环较小的患者来说是一项技术挑战。在本研究中，我们评估了在先前瓣膜手术后，使用自组装带瓣管道，对主动脉瓣和二尖瓣瓣环较小的患者进行“烟囱”式“突击”手术的安全性和早期结局。
2021年4月至2022年4月，对30例连续行“烟囱”式“突击”手术的患者，采用自组装带瓣管道及其他联合心脏手术，为主动脉根部较小的再次手术患者进行了完整手术。数据通过对中国武汉亚洲心脏病医院的病历审查获得。
患者平均年龄为52.7±13.53岁，女性占93.3%。所有患者均曾接受心脏瓣膜手术，其中90%接受了双瓣置换术（DVR）。3.3%（n = 1）的患者因恶性心律失常和多器官衰竭发生医院死亡。术后超声心动图检查显示，主动脉瓣和二尖瓣人工瓣膜大小分别为24.23±1.60mm和28.33±1.21mm。所有患者的瓣间隔纤维（IVF）修复完好，且无患者左心腔连通出现异常。除1例术后病态窦房结综合征和1例因出血行再次胸骨切开术外，无明显术后并发症，如死亡率、需要持续透析的肾衰竭或纵隔炎。术后第6个月的超声心动图检查显示，主动脉瓣和二尖瓣的平均跨瓣压差分别为16.26±6.44mmHg和11.24±4.90mmHg。
与标准“突击”手术相比，“烟囱”式“突击”手术的早期结局和安全性被证明是先前瓣膜手术后主动脉瓣和二尖瓣瓣环较小患者的一种可行治疗选择。这种方法能够扩大主动脉瓣和二尖瓣瓣环，并植入必要的人工瓣膜。
