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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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Successful Commando procedure using the superior transseptal approach in a high-risk case

Hiroki Moriuchi1, Mamoru Orii2, Takayuki Fujii2

  • 1Department of Cardiovascular Surgery, Yuai Medical Center, Yone 50-5, Tomigusuku, Okinawa, Japan. porimori22@gmail.com.

General Thoracic and Cardiovascular Surgery Cases
|September 2, 2025
PubMed

Insights

The superior transseptal approach enhances the complex Commando procedure for aortic and mitral valve replacement, offering better surgical field exposure and reducing tissue injury risks in challenging cardiac cases.

Area of Science:

  • Cardiac Surgery
  • Cardiovascular Medicine
  • Surgical Techniques

Background:

  • The Commando procedure, involving aortic and mitral valve replacement with intervalvular fibrous body reconstruction, is complex.
  • Standard surgical access may be limited by extensive adhesions from prior cardiac surgeries.
  • A superior transseptal incision can improve operative exposure and minimize surrounding tissue damage.

Purpose of the Study:

  • To evaluate the efficacy of a superior transseptal approach for the Commando procedure.
  • To demonstrate a modified surgical technique for complex valve replacement cases.

Main Methods:

  • A 48-year-old female patient with multiple comorbidities underwent the Commando procedure.
  • Severe aortic and mitral stenosis were addressed using a superior transseptal approach.
  • Aortic and mitral valves were replaced with 25-mm INSPIRIS and 25-mm MITRIS prostheses, respectively.
  • Intervalvular fibrous body reconstruction was performed using a bovine pericardium patch.

Main Results:

  • The superior transseptal approach provided excellent surgical exposure.
  • A stable operative field was maintained throughout the complex procedure.
  • The patient recovered without major complications.

Conclusions:

  • The superior transseptal approach is a valuable modification for the Commando procedure.
  • This technique facilitates standardized surgical maneuvers in patients with extensive adhesions.
  • It improves safety and efficacy in complex aortic and mitral valve replacement surgeries.
Abstract

Keywords:
Annular enlargementCommando procedureSuperior transseptal approach

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