Month: June 2026

JTCVS Open. 2025 Dec 19;29:101566. doi: 10.1016/j.xjon.2025.101566. eCollection 2026 Feb.

ABSTRACT

OBJECTIVE: We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).

METHODS: A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed. Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention. Explanatory variables included primary indication for the Commando approach and patch material, among others. Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity.

RESULTS: Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehyde-preserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP). There were 4 (5.6%) operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity. Of the 67 operative survivors, there were 18 (26.9%) deaths and 14 (20.9%) reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years). Patch material was not associated with late death. On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8, P = .03) versus GPBP/AP. Of the 14 reinterventions, 12 (85.7%) were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%] patients, redo-Commando operation in 4 [33.3%] patients, and transcatheter fistula occlusion in 5 [41.7%] patients). Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7, P = .02), compared to use of GPBP/AP.

CONCLUSIONS: Patch material influences reintervention risk following the Commando operation.

PMID:41960090 | PMC:PMC13059984 | DOI:10.1016/j.xjon.2025.101566

JTCVS Open. 2025 Dec 19;29:101566. doi: 10.1016/j.xjon.2025.101566. eCollection 2026 Feb.

ABSTRACT

OBJECTIVE: We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).

METHODS: A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed. Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention. Explanatory variables included primary indication for the Commando approach and patch material, among others. Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity.

RESULTS: Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehyde-preserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP). There were 4 (5.6%) operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity. Of the 67 operative survivors, there were 18 (26.9%) deaths and 14 (20.9%) reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years). Patch material was not associated with late death. On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8, P = .03) versus GPBP/AP. Of the 14 reinterventions, 12 (85.7%) were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%] patients, redo-Commando operation in 4 [33.3%] patients, and transcatheter fistula occlusion in 5 [41.7%] patients). Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7, P = .02), compared to use of GPBP/AP.

CONCLUSIONS: Patch material influences reintervention risk following the Commando operation.

PMID:41960090 | PMC:PMC13059984 | DOI:10.1016/j.xjon.2025.101566

Surg Case Rep. 2026;12(1):25-0728. doi: 10.70352/scrj.cr.25-0728. Epub 2026 Apr 1.

ABSTRACT

INTRODUCTION: Posterobasal ventricular septal rupture (P-VSR) developed after acute myocardial infarction (AMI) is often associated with right ventricular infarction and carries a high surgical mortality. The coexistence of tricuspid regurgitation (TR) further aggravates right ventricular dysfunction and right heart failure. Therefore, surgical repair of P-VSR complicated by right ventricular infarction and severe TR is particularly challenging.

CASE PRESENTATION: A 75-year-old woman developed acute inferior myocardial infarction complicated by right ventricular infarction. A coronary stent was deployed for right coronary artery occlusion. On day 16 after the onset of AMI, transthoracic echocardiography revealed a P-VSR and severe TR, and she was transferred to our institution for surgical management. Through a right atrial approach, excellent visualization of the P-VSR was obtained. The septal defect was closed securely using two bovine pericardial patches placed on both the right and left ventricular sides of the ventricular septum. Tricuspid valve replacement (TVR) was also performed. Postoperative echocardiography confirmed complete closure of the defect without residual shunt.

CONCLUSIONS: In the surgical treatment of P-VSR complicated by severe TR, a right atrial approach may provide adequate exposure of the septal defect while potentially minimizing additional ventricular injury. In selected patients with severe TR in a similar anatomical and clinical context, concomitant TVR may represent a feasible surgical option.

PMID:41940043 | PMC:PMC13044581 | DOI:10.70352/scrj.cr.25-0728