HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dübener, L. Articles by Schäfers, H.-J. Search for Related Content PubMed Articles by Dübener, L. Articles by Schäfers, H.-J.

Eur J Cardiothorac Surg 2000;18:741
© 2000 Elsevier Science NL

Letter to the Editor

Reply to Nagy and Péterffy

Department of Thoracic and Cardiovascular Surgery, University Hospitals, 66421 Homburg/Saar, Germany

Corresponding author. Tel.: +49-6841-162-501; fax: +49-6841-162-788
e-mail: chhjsc{at}med-rz.uni-sb.de

We would like to thank Drs Nagy and Péterffy for their considerations on mitral reconstruction without the use of annuloplasty ring, and thank them for their interest in our work.

While it is generally accepted that Carpentier's philosophy of implanting a rigid ring has resulted in good long-term stabilization of mitral ring size, its rigidity also impairs physiologic motion of the mitral ring during the cardiac cycle. In addition, its cost in European countries is approximately US$ 600 and thus not insignificant. Suture annuloplasty achieves a similar goal, i.e. reduction of the mitral orifice and improved leaflet cooperation without the physiologic disadvantages of a rigid structure and at a much lower price. In addition, it requires less ischemic time compared to implantation of an annuloplasty ring.

Drs Nagy and Péterffy very correctly point out two technical aspects of suture annuloplasty that need to be taken into consideration. The individual bites of the continuous suture have to be placed deep enough into the fibrous tissue of the mitral ring to prevent it from tearing out; we can only reiterate this point. The second aspect concerns the choice of suture material. Prolene sutures are now standard in most cardiac and cardiovascular procedures due to the stability of the material and the minimal degree of tissue drag. Minimal tissue drag appears advantageous during implantation since only small changes in suture tension will easily alter the size of the mitral orifice. Since prolene leads to minimal fibrosis, however, breakage in a chronic stage or knot disruption may lead to recurrence of ring dilatation. Different suture material, such as polytetrafluoroethylene is more difficult to place and adjust the orifice due to its increased tissue drag. It usually results in a stronger fibrous tissue reaction and possible ingrowth of connective tissue into the suture material itself. These connective tissue reactions can be expected to improve long-term stability of mitral repair even in the face of suture breakage, as can be concluded from the experience of Drs Nagy and Péterffy. Also we have not yet seen recurrent ring dilatation after suture annuloplasty using Gore-Tex material.

We agree with Drs Nagy and Péterffy that suture annuloplasty is a very effective means of reducing and stabilizing ring size in mitral reconstruction. We would like to encourage the authors to follow their patients further and produce 10-year follow-up results to provide true long-term data for comparison with ring annuloplasty.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dübener, L. Articles by Schäfers, H.-J. Search for Related Content PubMed Articles by Dübener, L. Articles by Schäfers, H.-J.