Back to Search
Start Over
Surgical Outcomes After Reconstruction of the Aortomitral Curtain.
- Source :
-
Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2024 Summer; Vol. 36 (2), pp. 158-166. Date of Electronic Publication: 2022 Dec 06. - Publication Year :
- 2024
-
Abstract
- Repair of concomitant aortic and mitral valvular disease with involvement of the aortomitral curtain requires a technically complex operation colloquially termed the commando procedure. Surgical outcomes of this procedure are not well described. The objective of this study was to examine outcomes of the commando procedure at our center. We identified all patients undergoing concomitant aortic and mitral valve replacements from 2004-2021. Of 363 patients, 41 underwent reconstruction of the aortomitral curtain. Survival analysis and multivariable modeling were used to examine outcomes and risk factors for mortality. The median age was 52 (IQR 44-71) years. Preoperatively, 4 of 41 (9.8%) patients had renal failure, and 10 of 41 (24.4%) had a stroke. The most common surgical indication was endocarditis in 25 of 41 (61.0%) patients. 25 of 41 (61.0%) patients underwent redo sternotomy, and 23 of 41 (56.1%) had previous prosthetic valves. Operative mortality was 14 of 41 (34.1%), and 8 of 41 (9.5%) patients received a permanent pacemaker. Survival at 1, 3, and 5 years was 55.4% (95% confidence interval (CI), 40.6-75.5%), 50.3% (35.0-72.3%), and 37.7% (19.3-73.9%) respectively. Cox proportional hazards regression identified previous sternotomy (HR 4.76, 95% CI 1.21-18.73), and female gender (HR 1.39, 95% CI 1.17-13.82) as risk factors for mortality. Patients undergoing reconstruction of the aortomitral curtain represent a high-risk population with complex surgical indications. Due to high perioperative morbidity and mortality, this procedure should be performed only when necessary. Despite a high up front morbidity burden, outcomes remain favorable for patients who survive the initial hospitalization.<br /> (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Risk Factors
Middle Aged
Aged
Treatment Outcome
Time Factors
Adult
Retrospective Studies
Risk Assessment
Heart Valve Diseases surgery
Heart Valve Diseases mortality
Heart Valve Diseases diagnostic imaging
Heart Valve Diseases physiopathology
Aortic Valve Disease surgery
Aortic Valve Disease mortality
Mitral Valve surgery
Mitral Valve physiopathology
Mitral Valve diagnostic imaging
Postoperative Complications etiology
Postoperative Complications mortality
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation mortality
Heart Valve Prosthesis Implantation instrumentation
Aortic Valve surgery
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-9488
- Volume :
- 36
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Seminars in thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 36481412
- Full Text :
- https://doi.org/10.1053/j.semtcvs.2022.11.008