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Ann Thorac Surg 1995;60:1185-1186
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1177.

DR LAWRENCE I. BONCHEK (Lancaster, PA): This fascinating presentation introduces yet another of Professor Carpentier's innovations in surgery of the mitral valve. I apologize if some of my questions are dealt with in the manuscript, but I was unable to obtain a copy in advance.

Since I observed Professor Carpentier demonstrating his techniques in Paris in 1981, we have had a favorable experience with the classic Carpentier-Edwards ring in almost 250 patients in Milwaukee and Lancaster. Yet, some years ago we were persuaded by reports in the literature to assess a flexible ring, and we inserted a Puig-Massana ring in 12 patients because it had some appealing design features.

We then reviewed our results in a group of patients we had operated on up to that time, and the reoperation rate in 142 patients was 3% with the Carpentier-Edwards ring, but with the Puig-Massana ring it was 25%. The average postoperative interval for reoperation was 2.1 years. Because of this experience we abandoned the use of totally flexible rings. I believe that the classic Carpentier-Edwards ring provides predictable and stable results in the hands of most surgeons because it corrects annular distortion in the manner that Professor Carpentier has always emphasized, including a reduction in the anteroposterior diameter of the annulus.

Our cardiologists are currently reviewing all of our postoperative echocardiograms, and they have not seen postoperative systolic anterior motion or left ventricular outflow obstruction in any of our patients. We attribute this to aggressive use of the sliding plasty technique with reduction in height of the posterior leaflet, supplemented by insertion of artificial chords of Gore-Tex to the posterior leaflet if there is a localized imperfection in the line of closure that could displace the anterior leaflet. These Gore-Tex chords can be inserted even after . . . [Full Text of this Article]

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The ``Physio-Ring'': An Advanced Concept in Mitral Valve Annuloplasty

Alain F. Carpentier, Arrigo Lessana, John Y. M. Relland, Emre Belli, Serban Mihaileanu, Alain J. Berrebi, Evelyn Palsky, and Didier F. Loulmet
Ann. Thorac. Surg. 1995 60: 1177-1185. [Abstract] [Full Text]