• James A Brown, Nina M Verghis, Sarah Yousef, Derek Serna-Gallegos, Jianhui Zhu, Floyd Thoma, David Kaczorowski, Danny Chu, Johannes Bonatti, Pyongsoo Yoon, Julie Phillippi, and Ibrahim Sultan.
• Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 1; 38 (4): 905910905-910.

ObjectivesTo describe outcomes of reconstruction of the aortomitral continuity (AMC) during concomitant aortic and mitral valve replacement (ie, the "Commando" procedure).DesignA retrospective study of consecutive cardiac surgeries from 2010 to 2022.SettingAt a single institution.ParticipantsAll patients undergoing double aortic and mitral valve replacement.InterventionsPatients were dichotomized by the performance (or not) of AMC reconstruction.Measurements And Main ResultsA total of 331 patients underwent double-valve replacement, of whom 21 patients (6.3%) had a Commando procedure. The Commando group was more likely to have had a previous aortic valve replacement (AVR) or mitral valve replacement (MVR) (66.7% v 27.4%, p < 0.001), redo cardiac surgery (71.4% v 31.3%, p < 0.001), and emergent/salvage surgery (14.3% v 1.61%, p = 0.001), whereas surgery was more often performed for endocarditis in the Commando group (52.4% v 22.9%, p = 0.003). The Commando group had higher operative mortality (28.6% v 10.7%, p = 0.014), more prolonged ventilation (61.9% v 31.9%, p = 0.005), longer cardiopulmonary bypass time (312 ± 118 v 218 ± 85 minutes, p < 0.001), and longer ischemic time (252 ± 90 v 176 ± 66 minutes, p < 0.001). Despite increased short-term morbidity in the Commando group, Kaplan-Meier survival estimation showed no difference in long-term survival between each group (p = 0.386, log-rank). On multivariate Cox analysis, the Commando procedure was not associated with an increased hazard of death, compared to MVR + AVR (hazard ratio 1.29, 95% CI: 0.65-2.59, p = 0.496).ConclusionsAlthough short-term postoperative morbidity and mortality were found to be higher for patients undergoing the Commando procedure, AMC reconstruction may be equally durable in the long term.Copyright © 2024 Elsevier Inc. All rights reserved.

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