The Commando procedure for pediatric patients: A case series

The Commando procedure for pediatric patients undergoing multi-redo operations.

Figure 1. A, Right atrium–transseptal incision is joining the aortotomy at the dome of the LA. B, The previous AV and MV are removed carefully, and the aortomitral curtain is divided. C, The MV is implanted first, and then a single large oval-shaped bovine pericardial patch that is folded on itself is secured to the cut edges. The MV implantation is completed with approximately one-third of the mitral prosthesis secured on the patch. A few millimeters of the patch are left between the mitral and aortic prosthesis suture lines to avoid competition for each valve. D, The upper half of the patch is used to reconstruct the ascending aorta and the lower portion to reconstruct the roof of the LA. The atrial septum can be patched using another patch. SVC, Superior vena cava; Ao, aorta; PA, pulmonary artery; IVC, inferior vena cava; AoV, aortic valve; MV, mitral valve.

Figure 2. The Commando procedure can be performed safely and provides excellent early to midterm results for pediatric patients with combined AV and MV disease. LVOT, Left ventricular outflow tract; Ao, aorta; AoV, aortic valve; AV, aortic valve; MV, mitral valve; mPG, mean pressure gradient.