Type of patch material affects midterm outcomes of combined aortic and mitral valve replacement and aortomitral curtain reconstruction

Objective: We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).Methods: A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed.Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention.Explanatory variables included primary indication for the Commando approach and patch material, among others.Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity. Results:Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehydepreserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP).There were 4 (5.6%)operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity.Of the 67 operative survivors, there were 18 (26.9%)deaths and 14 (20.9%)reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years).Patch material was not associated with late death.On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8,P = .03)versus GPBP/AP.Of the 14 reinterventions, 12 (85.7%)were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%]patients, redo-Commando operation in 4 [33.3%]patients, and transcatheter fistula occlusion in 5 [41.7%] patients).Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7,P = .02),compared to use of GPBP/AP.Conclusions: Patch material influences reintervention risk following the Commando operation.