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Eur J Cardiothorac Surg 2006;29:854-855
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Izumoto

Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, United States

Received 29 January 2006; accepted 31 January 2006.

^_* Tel.: +1 312 9426370; fax: +1 312 9426052. (Email: heartandbones{at}yahoo.com).

Key Words: Valve disease

I would like to thank Dr Izumoto for his thoughtful comments regarding aortic valve repair. As he pointed out, many of the articles cited had a large percentage of rheumatic valves that were repaired. As rheumatic heart disease is a progressive and relentless type of pathology, the results with repair were much worse in this cohort than in those without the disease. Ideally, Dr Savage and I would have loved to separate out all those with rheumatic heart disease and compare the outcomes of repair to those without the condition, and that would be an exceptionally good publication! Unfortunately, since the individual articles that were included in our manuscript did not separate out the results by type of pathology in every instance, this was simply not possible. However, several articles, such as those by Al-Halees et al. [1], Duran et al. [2], Amano et al. [3], and Grinda et al. [4] had mostly rheumatic patients (78–100%), which allowed us to draw the conclusions in the paper.

In addition, it is important to understand that one of the main reasons for attempting aortic valve repair is because the patients are young. The two main aortic valve pathologies found in young patients are rheumatic and congenital. Calcific or degenerative aortic disease will be found in older patients in whom we already have a good therapy: prosthetic replacement. There may not be much justification for attempting repair in these patients, and therefore it is important to describe the results in the specific patient population in whom repair has been tried, namely the young patient with rheumatic or congenital pathology. Thus far, repair does not seem to have durable results in the rheumatic population. We must hope that the congenital population will fare better.

Dr Izumoto's second point is also well taken. Many different types of repair were described in each case series and it was very difficult to ascertain which methods of repair were successful and which were not. It is currently unknown if a triangular resection may perform better than a leaflet placation. This is another area where future research will need to be done. I again thank Dr Izumoto for his insightful comments in an area where he has a great deal of expertise.

References

1. Al-Halees Z, Gometza B, Al Sanei A, Duran C. Repair of moderate aortic valve lesions associated with other pathology: an 11-year follow-up. Eur J Cardiothorac Surg 2001;20:247-251.[Abstract/Free Full Text]
2. Duran CMG, Gometza B, Kumar N, Gallo R, Bjornstad K. From aortic cusp extension to valve replacement with stentless pericardium. Ann Thorac Surg 1995;60:S428-S432.[CrossRef][Medline]
3. Amano J, Suzuki A, Sunamori M. Long term results of reconstructive surgery for acquired valve disease: evaluation of mitral and aortic valvuloplasty. Thorac Cardiovasc Surg 1994;42:9-13.[Medline]
4. Grinda JM, Latremouille C, Berrebi AJ, Zegdi R, Chauvaud S, Carpentier AF, Fabiani JN, Deloche A. Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results. Ann Thorac Surg 2002;74:438-443.[Abstract/Free Full Text]

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 Author home page(s): John Alfred Carr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Carr, J. A. Search for Related Content PubMed Articles by Carr, J. A. Related Collections Valve disease