Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia..
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2024;27:61-62. doi: 10.1053/j.pcsu.2024.01.006. Epub 2024 Jan 24.
The so-called Commando procedure, initially described by David and colleagues, consists in the reconstruction of the mitro-aortic fibrous lamina by a patch that enlarges both annuli. Its use has been described to upsize the aortic and mitral annulus for double valve replacement in adolescents. We describe a modified technique of this reconstruction of the fibrous skeleton of the heart, combined with Konno procedure to further enlarge the aortic annulus. In modified Commando procedure, following the reconstruction of aortomitral continuity with a bovine pericardium CardioCel patch (Admedus Regen Pty Ltd, Perth, WA, Australia), an aortic valved conduit that was made on the bench in order to have bottom skirt that enabled the suturing of the composite conduit far inside the left ventricle outflow tract. Coronary buttons were implanted at the supra-commissural level. The advantages of this modified Commando procedure are (1) the creation of a new aortic annulus when the integrity of this annulus has been compromised, (2) the upsizing of both annuli to any possible size of aortic and mitral prostheses, and (3) the relief of any residual left ventricular outflow tract obstruction.
所谓的 Commando 手术，最初由 David 等人描述，包括通过扩大两个环来重建二尖瓣-主动脉纤维层。该技术已被用于扩大青少年双瓣置换术的主动脉瓣环和二尖瓣环。我们描述了一种改良的心脏纤维骨骼重建技术，结合 Konno 手术进一步扩大主动脉瓣环。在改良的 Commando 手术中，使用牛心包 CardioCel 补丁（Admedus Regen Pty Ltd，Perth，WA，澳大利亚）重建主-二尖瓣连续性后，在台上制作一个带底裙的主动脉带瓣管道，以便能够将复合管道缝合到左心室流出道的深处。在窦上水平植入冠状动脉瓣。这种改良的 Commando 手术的优点是：(1) 在主动脉瓣环完整性受损时，可创建一个新的主动脉瓣环；(2) 可将两个瓣环扩大到任何大小的主动脉瓣和二尖瓣假体；(3) 可缓解任何残留的左心室流出道梗阻。
