Commando与Hemi-Commando术式在主动脉幕帘重建中的应用

Application of Commando and Hemi-Commando procedures in the reconstruction of intervalvular fibrous body

目的分析应用Commando和Hemi-Commando手术行主动脉幕帘重建的短-中期结局。方法连续性收集2014年9月—2022年9月于广东省人民医院行Commando或Hemi-Commando手术重建主动脉幕帘患者的临床资料,分析患者的治疗效果。结果共纳入18例患者,Commando手术组11例,其中男4例、女7例,中位年龄61(33,68)岁;Hemi-Commando手术组7例,其中男5例、女2例,中位年龄50(36,58)岁。Commando手术组1例、Hemi-Commando手术组2例患者术后30 d内死亡,低心排血量综合征合并多器官功能衰竭为主要死因。15例患者顺利康复出院且均获随访,中位随访时间13(6,42)个月,生存率100%。免于感染性心内膜炎复发率和免于再次手术率均为100%。结论Commando和Hemi-Commando手术是重建主动脉幕帘的有效手术方案,并且在度过术后急性期后能获得良好的中期预后。

Objective To analyze the short-and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body(IVFB)via double valve replacement(Commando procedure)or aortic valve replacement and mitral valve repair(Hemi-Commando procedure).Methods The patients who underwent Commando or HemiCommando procedure between September 2014 and September 2022 in Guangdong Provincial People's Hospital were collected.The perioperative and follow-up data were reviewed and analyzed for the assessment of short-and mid-term outcomes.Results Eleven patients received Commando procedure(a Commando group),including 4 males and 7females with a median age of 61(33,68)years;7 patients received Hemi-Commando procedure(a Hemi-Commando group),including 5 males and 2 females with a median age of 50(36,58)years.Two patients died in the postoperative 30days(1 patient in the Commando group and 2 patients in the Hemi-commando group).Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death.Fifteen patients were discharged and followed up for 13(6,42)months,with a survival rate of 100%.The rates of free from recurrent endocarditis or reoperation were both 100%.Conclusion Commando and Hemi-Commando procedures are effective strategies for IVFB reconstruction,and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.