Ann Thorac Surg 2005;80:975
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Antonio F. Corno, MD
Alder Hey Royal Children Hospital, Eaton Rd, Liverpool, L12 2AP, UK
(Email: antonio.corno{at}rlc.nhs.uk).
The article by Attmann and co-workers [1] addresses a timely and important topic. Within the last few years at almost every meeting of cardiologists and cardiac surgeons a session concerned one of the two following topics: (1) what are the indications for pulmonary valve implantation in the presence of pulmonary valve insufficiency? (2) what is the best technique for pulmonary valve implantation? Of course both questions are closely correlated, since the indication always depends upon the results of currently available techniques.
Attman and co-workers have dedicated only a small amount of discussion to the first topic. However, we, as cardiac surgeons, should not leave the entire decision-making responsibility regarding pulmonary valve insufficiency to our cardiology colleagues. The problem most frequently is a late complication after repair of tetralogy of Fallot with a trans-annular patch. We should provide cardiologists with the experimental and clinical evidence that justifies the need for a pulmonary valve; the benefits and long-term results of an implanted pulmonary valve; and the currently available techniques and associated risks of pulmonary valve implantation.
With regard to the second topic, this study is an additional contribution searching for the "best" (since the "ideal" remains a dream) technique for pulmonary valve implantation. The explosive interest of cardiologists in percutaneous valve techniques almost equals that of their colleagues treating patients with coronary artery disease with any available type of intra-coronary stent. Their interest was initially justified by erroneous information that conventional pulmonary valve implantation using cardiopulmonary bypass was associated with a substantial mortality and morbidity. In reality, several clinics report large series of patients, who had pulmonary valve implantation with cardiopulmonary bypass, without aortic cross clamp, using femoral arterial and venous cannulation, with a mortality of 1% or less. Furthermore our new technique, developed in animal studies, permits the "off-bypass pulmonary valve implantation" through a median sternotomy or thoracotomy and is on the verge of clinical application. The experimental study reported by Attman and co-workers is another valuable contribution in the development of biological materials for pulmonary valve implantation and may be utilized by both cardiologists and cardiac surgeons as a "hybrid approach" as opposed to a "passing fancy."
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- Attmann T, Jahnke T, Quaden R, et al. Advances in experimental percutaneous pulmonary valve replacement Ann Thorac Surg 2005;80:969-975.[Abstract/Free Full Text]
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