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Updated: Jul 9, 2026

Translational Rabbit Model of Chronic Cardiac Pacing

Translational Rabbit Model of Chronic Cardiac Pacing

Published on: January 6, 2023

Permanent pacemaker rate following Commando and Hemi-Commando procedures: a systematic review and meta-analysis.

Yang Zhang¹, Ren Zhu¹, Guanshui Yu¹

¹Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Maoming, China.

Frontiers in Cardiovascular Medicine

|July 8, 2026

Summary

The Commando procedure often requires a permanent pacemaker, with a pooled rate of 22.3%. The Chimney Commando modification shows a significantly lower rate (6.3%), suggesting a potentially safer alternative.

Keywords:

commando procedure heart block meta-analysis permanent pacemaker systematic review

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Last Updated: Jul 9, 2026

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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

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Published on: June 12, 2021

Area of Science:

Cardiovascular Surgery
Medical Device Implantation

Background:

The Commando procedure, involving double-valve replacement and intervalvular fibrous body reconstruction, carries a significant risk of atrioventricular block.
This necessitates permanent pacemaker implantation in a substantial number of patients, with existing estimates showing wide variability.

Purpose of the Study:

To systematically review and meta-analyze existing literature to determine the pooled permanent pacemaker rate following Commando and Hemi-Commando procedures.
To compare the permanent pacemaker rates between different modifications of the Commando procedure.

Main Methods:

A comprehensive search of major databases (PubMed, Embase, Web of Science, Cochrane CENTRAL) was conducted up to April 2, 2026.
Twelve studies comprising 797 patients were included, with data pooled using a random-effects model and logit transformation.
Subgroup, sensitivity, and publication bias analyses were performed to assess the robustness and potential biases of the findings.

Main Results:

The overall pooled permanent pacemaker rate after Commando and Hemi-Commando procedures was 22.3% (95% CI: 16.1%-30.0%), with significant heterogeneity observed (I² = 73.7%).
The Chimney Commando modification demonstrated a significantly lower permanent pacemaker rate (6.3%) compared to the traditional Commando procedure (28.3%) (p < 0.001).
Sensitivity analyses supported the findings, though Egger's test suggested potential small-study effects (p = 0.0041).

Conclusions:

Approximately one in five patients undergoing Commando surgery requires a permanent pacemaker.
The Chimney Commando modification appears to be associated with a substantially lower risk of permanent pacemaker implantation.
While promising, these findings are preliminary and hypothesis-generating; further prospective studies are needed to validate the benefits of the Chimney technique, particularly in high-risk patient groups.