Early outcomes of chimney commando procedure in redo double valve replacement: A retrospective cohort study.

Abstract

To assess the early outcomes of the chimney commando (CC) procedure in patients who underwent redo double valve replacement (DVR) with and without CC. A retrospective cohort study of 194 patients undergoing redo DVR at Wuhan Asia Heart Hospital from December 2019 to December 2024. One hundred one patients were in the CC + DVR group and 93 were in an isolated DVR group. A total of 188 patients completed follow-up, The median follow-up time was 14 months (range, 6-36 months). The primary outcome was 30-day mortality; secondary outcomes were postoperative complications and hemodynamics. After surgery, the median labeled size increase was 4 (interquartile range, 2.0-6.0) for aortic and 2 (interquartile range, 2-4) for mitral valves in the CC + DVR group, with no change in the DVR group. The effective orifice area (2.0 ± 0.1 vs 1.8 ± 0.1 cm²; P < .001) and effective orifice area index (1.3 ± 0.1 vs 1.2 ± 0.1 cm²/m²; P < .001) were significantly larger in the CC + DVR group. The aortic valve maximum velocity in the CC + DVR group (1.9 ± 0.3 vs 2.3 ± 0.4 m/second; P < .001) were lower than in the DVR group, with these hemodynamic benefits sustained during follow-up. Postoperative complications showed no significant differences (P > .05). Thirty-day all-cause mortality was similar (2.8% vs 1.4%; P = 1.000) after adjustment. One patient from the CC + DVR group died from a cerebral infarction 2 months after surgery. The CC procedure maybe a safe and effective solution for redo DVR with double small annuli, offering good hemodynamics and favorable early outcomes. Long-term outcomes still require further follow-up. Annular enlargement may also facilitate future transcatheter valve implantation.