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Ann Thorac Surg 2002;73:1021
© 2002 The Society of Thoracic Surgeons
a IMC—International Innovative Medical Care Center, Krustettnerstrasse, A-3506 Krems/Hollenburg, Austria
e-mail: rfasol{at}imc-hospital.com
To the Editor
The report of Aoyagi and colleagues is very encouraging and positively confirms our own clinical results as well as those of others, specifically the data of Colvin and Galloway from New York, who repeatedly published their experiences and results of triangular resection of the anterior mitral valve leaflet [1, 2]. However, the issue of selecting the correct surgical technique and strategy for repairing isolated segmental prolapse of the anterior leaflet may be controversial. As previously discussed [3], it seems that three methods enjoy some sort of acceptance: the implantation of artificial chordae, transposition of chordae, and Alfieri’s technique of a bow-tie-repair. However, none of these three described techniques are without problems and possible complications [3]. Interestingly, as just recently reported, Alfieri’s group seems to have reduced the application of their own technique significantly [4]. However, the surgical technique of a segmental triangular resection of a prolapsing anterior leaflet scallop seems to be an alternative, simple, and reliable way of repairing isolated segmental anterior mitral valve leaflet prolapse. Furthermore, recent reports confirm the results and favor this technique [1–3]. However, I think we face a psychological problem in that initially we all exclusively used techniques that Carpentier developed over the last two decades in Paris. We have more or less been glued to the subsequent reports of "to do’s" and "not to do’s." Therefore, a report from Paris [6] more than a decade ago seems to have banned this technique of segmental triangular resection of the prolapsing anterior leaflet scallop from the minds of most of us.
We should also consider that up to now mitral valve surgery is mainly characterized by contradicting and divergent opinions regarding therapeutic approaches, surgical techniques and procedures, and the choices of implantable devices. Relevant to this bias, some authors have found striking superiority of mitral valve reconstruction over valve replacement, whereas others have noted little differences. Although most surgeons advocate repair procedures, mitral valves are unfortunately more often replaced. This diversity of opinion reflects the variety of techniques used, comparison of heterogenous patient populations, and the importance of small numbers in most reports. [5]
References
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