Early Outcomes of Chimney Commando Procedure In Redo Double Valve Replacement: A Retrospective Cohort Study.

Objective: To assess the early outcomes of the Chimney Commando (CC) procedure in patients who underwent redo double valve replacement (DVR) with and without CC.

Methods: A retrospective cohort study of 194 patients undergoing redo double valve replacement (DVR) at Wuhan Asia Heart Hospital from December 2019 to December 2024. 101 patients were in CC+DVR group and 93 in isolated DVR group. A total of 188 patients completed follow-up, The median follow-up time was 14(6,36) months. The primary outcome was 30-day mortality; secondary outcomes was postoperative complications and hemodynamics.

Results: After surgery, the median labeled size increase: 4[ IQR:2.0, 6.0] for aortic, 2 [2,4]for mitral valves in CC+DVR group, with no change in DVR group. The EOA (2.0 ± 0.1cm2 vs. 1.8 ± 0.1cm2, P < 0.001) and EOAI (1.3 ± 0.1cm2/m2 vs. 1.2 ± 0.1cm2/m2, P < 0.001) were significantly larger in CC+DVR group. The aortic valve maximum velocity in CC+DVR group (1.9 ± 0.3m/s vs. 2.3 ± 0.4 m/s, P < 0.001) were lower than DVR group, with these hemodynamic benefits sustained during follow-up. Postoperative complications showed no significant differences (P > 0.05). 30-day all-cause mortality was similar (2.8% vs. 1.4%, P = 1.000) after adjustment. One patient from CC+DVR group died from a cerebral infarction two months after surgery.

Conclusions: The Chimney Commando procedure maybe a safe and effective solution for redo double valve replacement 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.