Application of Commando Surgery in Cardiac Double Valve Replacement
Objective The effectiveness and safety of Commando surgery in patients with small annulus combined with aortic mitral valve disease provide new clinical ideas and references for the surgical treatment of patients with small annulus,obvious annulus lesions and double valve replacement.Methods Convenience sampling method was used to select patients who underwent Commando surgery(aortic valve mitral valve curtain enlargement surgery and valve replacement surgery)in our hospital from April 2021 to May 2022 as the research objects.The effectiveness of the Commando procedure was analyzed by comparing the patients'clinical indices(internal diameter of the aortic annulus,mitral inflow velocity,mitral transvenous pressure difference,aortic inflow velocity,aortic transvenous pressure difference)and the incidence of complications before the procedure,at 5 days,1 month,3 months,and 12 months after the procedure.Results A total of 12 patients including 10 females and 2 males with a mean age of 55.75±12.61 years were included.The effective opening area index of aortic valve after operation ranged from 1.24 to 2.15,and the effective opening area index of mitral valve after operation ranged from 1.53 to 2.89.The results of generalized estimation equation showed that there were significant differences in aortic annulus diameter(Z=6.75,P<0.001),mitral valve blood flow velocity(Z=-9.35,P<0.001),mitral valve transpulse pressure(Z=-2.26,P=0.024),aortic valve blood flow velocity(Z=-5.47,P<0.001)and aortic valve transpulse pressure(Z=-4.82,P<0.001)before operation,5 days after operation,1 month after operation,3 months after operation and 12 months after operation.One-year survival rate was 91.67%,and the mortality rate was 8.33%(due to low cardiac output syndrome).Conclusion Commando surgical method is an effective overall solution for patients with small mitral annulus and small aortic annulus.It is a safe and effective treatment for patients undergoing double valve replacement surgery again.Patients with prosthesis-patient mismatch and valve dysfunction have obvious postoperative benefits.It can avoid reoperation or multiple surgical treatments,and improve the quality of life of patients.
Commando surgerySmall mitral annulusSmall aortic rootDouble-lobe ring enlargementValvular replacement