Chimney Commando modification lowers pacemaker rate to 6.3% in meta-analysisChimney Commando Modification Lowers Permanent Pacemaker Rates

Frontiers in Medicine Published June 23, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider the Chimney Commando modification to potentially lower permanent pacemaker rates, but interpret with caution due to high heterogeneity.

This meta-analysis of 12 studies (797 patients) evaluated permanent pacemaker rates after Commando and Hemi-Commando procedures, including a comparison between the Chimney Commando modification and the traditional Commando procedure. The pooled permanent pacemaker rate across all procedures was 22.3% (95% CI: 16.1%–30.0%).

For the Chimney Commando modification, the pooled pacemaker rate was 6.3% (95% CI: 3.2%–12.1%), while the traditional Commando procedure had a rate of 28.3% (95% CI: 21.2%–36.7%). The authors note that the Chimney modification was associated with a significantly lower pacemaker rate.

A key limitation is substantial heterogeneity across studies (I² = 73.7%), which may affect the reliability of pooled estimates. The analysis is based on pooled proportions from 12 studies, not individual patient-level data for the direct comparison.

These findings suggest that the Chimney Commando modification may reduce the need for permanent pacing, but the observational nature of the included studies and high heterogeneity warrant cautious interpretation. Further prospective studies are needed to confirm these results.

How this fits prior evidence

This meta-analysis extends prior coverage of cardiac structural interventions by providing pooled pacemaker rates for Commando procedures. The finding that the Chimney modification is associated with a lower pacemaker rate (6.3%) compared to the traditional procedure (28.3%) adds procedural-level evidence to the broader context of cardiac risk prediction, though the prior coverage focused on dynamic cardiac shape and cardiometabolic disease risk rather than surgical outcomes.

Researchers analyzed data from 797 patients to compare two types of heart surgery: the traditional Commando procedure and a modification called the Chimney Commando. The study looked specifically at how often patients needed a permanent pacemaker after their surgery.

The results showed that patients who underwent the Chimney Commando modification had a much lower rate of needing a permanent pacemaker, at 6.3 percent. In contrast, those who had the traditional Commando procedure had a higher rate of 28.3 percent. Overall, the average rate for all procedures combined was 22.3 percent.

Because this was a meta-analysis of several different studies, there was a lot of variation in how the data was collected. While the results show a clear link between the modified technique and fewer pacemakers, it is important to remember that these are pooled statistics rather than individual patient outcomes. Patients should talk with their doctors about which surgical approach is best for their specific heart condition.

What this means for you:

The Chimney Commando modification showed a lower rate of permanent pacemakers compared to traditional methods.

Common questions

What is the difference between these two procedures?

The study compared a traditional Commando procedure with a modification called the Chimney Commando. The main difference found was that the Chimney Commando modification was associated with a much lower rate of patients needing a permanent pacemaker, which was 6.3 percent compared to 28.3 percent for the traditional method.

How many people were included in this study?

The analysis included data from 797 patients across 12 different studies. These results help show how often a permanent pacemaker is needed after these specific heart procedures are performed.

Is the Chimney Commando modification safer for my heart?

The study found that the Chimney Commando modification was linked to lower rates of needing a permanent pacemaker. However, because this is an analysis of pooled data and not a single trial, you should discuss your specific risks and options with your cardiologist.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

ObjectiveThe Commando procedure (double-valve replacement with intervalvular fibrous body reconstruction) is associated with a high risk of postoperative atrioventricular block requiring permanent pacemaker implantation. However, precise estimates vary widely. This systematic review and meta-analysis aimed to determine the pooled permanent pacemaker rate after Commando and Hemi-Commando procedures.MethodsPubMed, Embase, Web of Science, and Cochrane CENTRAL were searched from inception to April 2, 2026. Studies reporting permanent pacemaker rates after Commando or Hemi-Commando surgery (sample size ≥ 5) were included. A random-effects model was used to pool proportions, with logit transformation. Subgroup analyses were performed by procedure type. Sensitivity analyses and publication bias assessment (Egger's test) were conducted.ResultsTwelve studies with 13 data points (797 patients) were included. The pooled permanent pacemaker rate was 22.3% (95% confidence interval: 16.1%–30.0%), with substantial heterogeneity (I² = 73.7%). Subgroup analysis showed that the Chimney Commando modification had a significantly lower rate (6.3%, 95% CI: 3.2%–12.1%) compared with the traditional Commando procedure (28.3%, 95% CI: 21.2%–36.7%; p for subgroup difference

Chimney Commando modification lowers pacemaker rate to 6.3% in meta-analysisChimney Commando Modification Lowers Permanent Pacemaker Rates

How this fits prior evidence

Common questions

Study Details

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Chimney Commando modification lowers pacemaker rate to 6.3% in meta-analysisChimney Commando Modification Lowers Permanent Pacemaker Rates

How this fits prior evidence

Common questions

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