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Outcomes of Aortomitral Continuity Reconstruction During Concomitant Aortic and Mitral Valve Replacement.
Brown, James A; Verghis, Nina M; Yousef, Sarah; Serna-Gallegos, Derek; Zhu, Jianhui; Thoma, Floyd; Kaczorowski, David; Chu, Danny; Bonatti, Johannes; Yoon, Pyongsoo; Phillippi, Julie; Sultan, Ibrahim.
Afiliação
  • Brown JA; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
  • Verghis NM; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
  • Yousef S; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
  • Serna-Gallegos D; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Zhu J; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Thoma F; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Kaczorowski D; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Chu D; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Bonatti J; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Yoon P; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Phillippi J; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Sultan I; Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: sultani@upmc.edu.
J Cardiothorac Vasc Anesth ; 38(4): 905-910, 2024 Apr.
Article em En | MEDLINE | ID: mdl-38350743
ABSTRACT

OBJECTIVES:

To describe outcomes of reconstruction of the aortomitral continuity (AMC) during concomitant aortic and mitral valve replacement (ie, the "Commando" procedure).

DESIGN:

A retrospective study of consecutive cardiac surgeries from 2010 to 2022.

SETTING:

At a single institution.

PARTICIPANTS:

All patients undergoing double aortic and mitral valve replacement.

INTERVENTIONS:

Patients were dichotomized by the performance (or not) of AMC reconstruction. MEASUREMENTS AND MAIN

RESULTS:

A 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).

CONCLUSIONS:

Although 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Implante de Prótese de Valva Cardíaca / Valva Mitral Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Assunto da revista: ANESTESIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Implante de Prótese de Valva Cardíaca / Valva Mitral Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: J Cardiothorac Vasc Anesth Assunto da revista: ANESTESIOLOGIA / CARDIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos