The "Commando" Procedure in Colombia: Early and Mid-Term Outcomes From the Largest Latin American Series

Reconstruction of the mitro-aortic fibrous, or "Commando," procedure has emerged as a radical but effective alternative in patients previously considered "inoperable." However, the low incidence of cases limits the procedures application and data. This study sought to evaluate early and mid-term outcomes in patients undergoing the "Commando" procedure at an institution in Colombia.

We conducted a single-institution, retrospective analysis of clinical, perioperative, and follow-up outcomes in patients who underwent the Commando procedure at a tertiary referral centre in northeastern Colombia between July 2018 and June 2025. Patients were categorized into endocarditis and non-endocarditis groups.

A total of 37 patients were included, with endocarditis as the most frequent cause in 29 cases (78.4%). The median age was 54 years (IQR 43-68), comparable between groups. Prior cardiac surgery was higher in the non-endocarditis group (100% vs 58.6%, P = .036). Operative mortality was 13.5%, all of them in the endocarditis group. Kaplan-Meier estimated overall survival after the Commando procedure was 80.3% at 1 year (95% CI, 63.0-90.1) and 59.2% at both 3 and 5 years. One-year survival was 78.5% (95% CI, 58.1-89.8%) in the endocarditis group vs 87.50% (95% CI, 38.7-98.1%) in the non-endocarditis group.

The Commando procedure can be performed safely in middle-income settings, with outcomes comparable to high-volume centres in developed countries. This study represents the largest Latin American series to date, showing that prognosis is driven more by disease severity than by socioeconomic context.