Ann Thorac Surg 2005;80:1705
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
David S. Bach, MD
The University of Michigan, L3119 Women's–0273, 1500 E Medical Center Dr, Ann Arbor, MI48109
(Email: dbach{at}umich.edu).
| Dr Bach discloses a financial relationship with Edwards Lifesciences, Medtronic, and St. Jude Medical.
|
The authors [1] are to be commended for their careful study of a large cohort of predominantly elderly patients who underwent aortic valve replacement with a Mitroflow Synergy pericardial prosthesis (Sorin Group Inc, Mitroflow Division, Vancouver, Canada). They conclude that the bioprosthesis is a reliable choice, especially in patients older than 75 years of age with a small aortic annulus. Previously published reports suggest that structural valve deterioration of this prosthesis is problematic in valve sizes greater than 25 mm and among patients younger than 70 years of age. The present report moves the target population to those with a small annulus and age greater than 75 years. Scrutiny of the present data confirms high rates of structural valve deterioration among patients less than 75 years, but also suggests significant attrition of structural integrity at 5 years among patients between 75 and 84 years at the time of surgery.
The ideal heart valve prosthesis may be the Holy Grail of heart valve surgery. We seek a prosthesis that has good hemodynamics, low rates of adverse events, and is durable. Is two out of three not bad? At present, with the availability of alternative heart valve prostheses that come increasing close to meeting all three criteria, it is difficult to imagine a rationale for the use a prosthesis that is known to deteriorate after only 5 years.
 |
References
|
|---|
- Minami K, Zitterman A, Schulte-Eistrup S, Koertke H, Körfer R. Mitroflow synergy prostheses for aortic valve replacement19 years experience with 1,516 patients. Ann Thorac Surg 2005;80:1699-1705.[Abstract/Free Full Text]
Top
References