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Mid-term outcomes following the Hemi-Commando procedure for complex infective endocarditis involving the aortomitral

Mateo Marin-Cuartas1, Manuela De La Cuesta1, Piroze M Davierwala2

  • 1University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 25, 2023
PubMed
Abstract

Insights

The Hemi-Commando procedure provides a viable mitral valve-sparing option for complex infective endocarditis (IE) involving the aortomitral junction (AMJ). Mid-term outcomes show acceptable survival and low reoperation rates, making it an alternative to the Commando procedure.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis Research
  • Cardiac Valve Repair

Background:

  • Perivalvular abscesses with aortomitral junction (AMJ) destruction are severe infective endocarditis (IE) complications.
  • These conditions are linked to high mortality and complex treatment challenges.
  • The Hemi-Commando procedure is a mitral valve-sparing alternative for specific IE cases.

Purpose of the Study:

  • To review mid-term outcomes of the Hemi-Commando procedure in patients with IE and AMJ destruction.
  • To evaluate the efficacy and safety of this valve-sparing approach.
  • To compare its outcomes against traditional methods.

Main Methods:

  • Retrospective analysis of clinical outcomes for 22 patients.
  • Patients underwent the Hemi-Commando procedure between 2015 and 2021.
  • Primary outcomes included 30-day mortality and 1-year survival; secondary outcome was 1-year freedom from reoperation.

Main Results:

  • The 30-day mortality rate was 13.6%.
  • Estimated 1- and 3-year survival rates were 77.5% and 66.4%, respectively.
  • Estimated freedom from reoperation at 1 and 3 years was 92.3%.

Conclusions:

  • The Hemi-Commando procedure demonstrates acceptable mid-term survival.
  • It is associated with low reoperation rates.
  • It represents a reasonable mitral valve-sparing alternative for extensive IE with perivalvular involvement.
Keywords:
Aortic valve replacementAortomitral junctionHemi-CommandoInfective endocarditisMitral valve repair

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