Key result
Modified aorto-mitral curtain patch reinforcement without posterior extension offers a Commando alternative for double valve replacement.
Why the study?
The Commando procedure is technically demanding, prompting the use of an alternative patch reinforcement technique when the aorto-mitral curtain is only partially destroyed or thinned out without active infection, severe calcification, or need for annular enlargement.
Describes a modified technique for patch reinforcement of the aorto-mitral curtain without posterior extension as an alternative to the Commando procedure in select patients.
May simplify aorto-mitral reconstruction in double valve replacement; leaves open comparative safety and durability versus the Commando procedure.
Commando reconstruction of the intervalvular fibrosa or aorto-mitral curtain (AMC) is a technically demanding procedure and complex undertaking reserved for double-valve invasive endocarditis or severely calcified radiation heart disease.1,2 According to the Commando technique, patch reconstruction of AMC is performed due to complete destruction of the AMC or in cases where significant annular upsizing is required to accommodate valve prostheses.3-5 In situations where the AMC is only partially destroyed or thinned out without active infection, significant calcification, or need for annular enlargement, we have utilized a modified technique of patch reinforcement of the AMC without posterior extension through the roof of the left atrium to reinforce the AMC and anchor the new valve prosthesis.
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Zaki et al. (2023) studied Double valve replacement requiring aorto-mitral curtain reconstruction. Patch reinforcement of the aorto-mitral curtain without posterior extension vs. Commando procedure was evaluated. A modified technique of patch reinforcement of the aorto-mitral curtain without posterior extension was described as an alternative to the Commando procedure for double valve replacement.
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