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Published on: December 11, 2017
Early outcomes of chimney commando procedure in redo double valve replacement: A retrospective cohort study
Hongyan Liu1, Zhengdong Hua1, Bihui He1
1Department of Cardiovascular Surgery, Wuhan Asia Heart Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, China.
Insights
The Chimney Commando (CC) procedure offers improved hemodynamics for redo double valve replacement (DVR) in patients with small annuli. This technique demonstrates safe and effective early outcomes, with no significant difference in mortality compared to isolated DVR.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Redo double valve replacement (DVR) can be challenging, particularly in cases of small annular size.
- The Chimney Commando (CC) procedure is an innovative technique for annular enlargement during cardiac surgery.
- Assessing the early outcomes of the CC procedure in redo DVR is crucial for patient management.
Purpose of the Study:
- To evaluate the early clinical and hemodynamic outcomes of the Chimney Commando (CC) procedure in patients undergoing redo double valve replacement (DVR).
- To compare outcomes between patients who received CC with DVR and those who underwent isolated DVR.
Main Methods:
- A retrospective cohort study included 194 patients undergoing redo DVR.
- 101 patients received CC+DVR, and 93 underwent isolated DVR.
- Follow-up was completed by 188 patients over a median of 14 months, assessing 30-day mortality, complications, and hemodynamics.
Main Results:
- The CC+DVR group showed significantly larger effective orifice area (EOA) and indexed EOA compared to the isolated DVR group.
- Aortic valve maximum velocity was lower in the CC+DVR group, indicating improved hemodynamics, which were sustained during follow-up.
- There were no significant differences in postoperative complications or 30-day all-cause mortality between the groups.
Conclusions:
- The Chimney Commando procedure is a safe and effective option for redo DVR in patients with small annuli, providing favorable early hemodynamic results.
- Annular enlargement via the CC technique may also facilitate future transcatheter valve interventions.
- Further long-term follow-up is necessary to fully ascertain the durability and benefits of the CC procedure.
Objective:
To assess the early outcomes of the chimney commando (CC) procedure in patients who underwent redo double valve replacement (DVR) with and without CC.
Methods:
A retrospective cohort study of 194 patients undergoing redo DVR at Wuhan Asia Heart Hospital from December 2019 to December 2024. One hundred one patients were in the CC + DVR group and 93 were in an isolated DVR group. A total of 188 patients completed follow-up, The median follow-up time was 14 months (range, 6-36 months). The primary outcome was 30-day mortality; secondary outcomes were postoperative complications and hemodynamics.
Results:
After surgery, the median labeled size increase was 4 (interquartile range, 2.0-6.0) for aortic and 2 (interquartile range, 2-4) for mitral valves in the CC + DVR group, with no change in the DVR group. The effective orifice area (2.0 ± 0.1 vs 1.8 ± 0.1 cm2; P < .001) and effective orifice area index (1.3 ± 0.1 vs 1.2 ± 0.1 cm2/m2; P < .001) were significantly larger in the CC + DVR group. The aortic valve maximum velocity in the CC + DVR group (1.9 ± 0.3 vs 2.3 ± 0.4 m/second; P < .001) were lower than in the DVR group, with these hemodynamic benefits sustained during follow-up. Postoperative complications showed no significant differences (P > .05). Thirty-day all-cause mortality was similar (2.8% vs 1.4%; P = 1.000) after adjustment. One patient from the CC + DVR group died from a cerebral infarction 2 months after surgery.
Conclusions:
The CC procedure maybe a safe and effective solution for redo DVR with double small annuli, offering good hemodynamics and favorable early outcomes. Long-term outcomes still require further follow-up. Annular enlargement may also facilitate future transcatheter valve implantation.
