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Updated: May 5, 2026
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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Contemporary experience with the Commando procedure for anterior mitral anular calcification
Mona Kakavand1, Filip Stembal1, Lin Chen2
1Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
JTCVS Open
|May 1, 2024
Summary
The Commando procedure offers acceptable outcomes for complex double-valve replacements, comparable to standard procedures. This technique reconstructs the intervalvular fibrosa, proving effective in challenging cases involving calcification and prior surgery.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Medical Device Technology
Background:
- Anterior mitral annular calcification and destroyed intervalvular fibrosa present significant challenges in double-valve replacement surgery.
- Radiation heart disease and prior valve surgery complicate prosthesis sizing and placement.
- The Commando procedure involves intervalvular fibrosa reconstruction to facilitate complex double-valve replacement.
Purpose of the Study:
- To evaluate the outcomes of the Commando procedure for double-valve replacement in patients with challenging anatomy.
- To compare the results of the Commando procedure with standard double-valve replacement techniques.
- To assess the safety and efficacy of intervalvular fibrosa reconstruction in complex cardiac surgeries.
Main Methods:
- A retrospective analysis compared 129 Commando procedures with 1191 standard double-valve replacements (DVR) from January 2011 to January 2022.
- Balancing-score methods were used to create matched pairs (109 pairs) for robust comparison.
- Outcomes including operative mortality, reoperation, survival, and valve gradients were analyzed.
Main Results:
- Commando procedures were performed for severe calcification (n=67), often post-radiation, and other complex reasons.
- Hospital outcomes were similar between Commando and standard DVR groups, including operative mortality and bleeding reoperations.
- Five-year survival was 54% for Commando vs. 67% for standard DVR (P=.33), with Commando showing lower aortic valve gradients at 4 years (9.4 vs. 11 mm Hg, P=.04).
Conclusions:
- The Commando procedure demonstrates acceptable outcomes for complex double-valve replacement, comparable to standard DVR.
- Reconstruction of the intervalvular fibrosa is feasible and effective in challenging calcified or radiation-damaged hearts.
- Further experience and long-term data are needed to optimize patient selection and application of the Commando approach.
Keywords:
double-valve replacementintervalvular fibrosa reconstructionradiation-associated cardiac diseaseMore Related Videos
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