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The Commando procedure for pediatric patients: A case series.

Hiroo Kinami1, David M Kalfa1, Andrew B Goldstone1

  • 1Department of Cardiac Surgery, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.

JTCVS Techniques
|June 16, 2023
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Summary

The Commando procedure, involving mitral and aortic valve replacement, demonstrated excellent outcomes in pediatric patients with complex heart conditions. This complex surgery showed no mortality or reoperations, significantly improving heart function.

Keywords:
Commando procedurecongenital cardiac surgerymultiple redo surgerypediatric

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The Commando procedure is a complex surgical technique for severe heart defects.
  • It traditionally carries a high risk of mortality.
  • This procedure involves division of the intervalvular fibrous body, mitral valve replacement, and aortic valve replacement.

Purpose of the Study:

  • To evaluate the safety and efficacy of the Commando procedure in pediatric patients.
  • To assess outcomes in patients with combined left ventricular inflow and outflow obstruction.

Main Methods:

  • Study included five pediatric patients with combined left ventricular inflow and outflow obstruction.
  • The Commando procedure was performed on all participants.

Main Results:

  • No early or late deaths were observed during follow-up.
  • No patients required pacemaker implantation or reoperation.
  • No clinically significant gradients across the mitral or aortic valves developed.

Conclusions:

  • The Commando procedure can be performed with excellent outcomes in select pediatric patients.
  • Benefits include achieving normal annular diameters and improved hemodynamics.
  • Risks must be weighed against benefits, especially in patients undergoing multiple redo operations.