RECONSTRUCTION OF LEFT VENTRICLE OUTFLOW TRACT AFTER ENDOCARDITIS: HOW WE DO IT

Backgrounds and aim: One of the most widely adopted and complex procedures to treat Infective Endocarditis (IE) is the Commando technique. We propose a retrospective survival analysis with a different procedure performed in our center: the reconstruction of the whole left ventricle outflow tract (LVOT) with a pericardial cylindrical patch. Methods: We selected patients admitted from 2004 to 2023. Cases had LVOT or aortic root abscess, both on native or prosthetic valves with or without mitral valve involvement. We focused on aortic clamp time, cardiopulmonary bypass time, overall survival (OS) and event free survival (EFS). Results: We found 80 consecutive patients. Mean age at surgery was 63 years old. Sixty-one percent had already required heart surgery. Prosthetic valve involvement was found in 52% of the population. At the time of the procedure, the average EF was 58%. Mean aortic-clamp time was 145,2 minutes and the average cardiopulmonary bypass time was 188,6 minutes. One-year OS and EFS was respectively 78,75% and 98,75%. Only 2 patients (1,6%) needed additional heart surgery in the first year after the procedure. Conclusions: The literature reports for Commando and hemi-Commando technique a cardiopulmonary bypass time of 250 minutes and an aortic-clamp time of 200 minutes, which are both longer than those reported in our experience. One year OS, EFS and reintervention rates are comparable to the available data in literature. This study has some limitations, still it would be worthy of further prospective case-control study to validate this less demolitive and apparently equally effective technique.