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Ann Thorac Surg 2006;81:788
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

Cardiac Surgical Associates P.A., 2356 University Ave W, Suite 258, St. Paul, MN 55114

(Email: dremery{at}esa-heart.com).

To the Editor:

The authors would like to thank Dr García-Rinaldi [1] for his kind comments regarding our recent article [2]. We believe substantial efforts were made in obtaining as complete a follow-up as possible (ie, 96% of patients contacted) in an effort to capture true event rates for the long term. In this regard, we concur with García-Rinaldi's conclusion that anticoagulation is the most important issue to approach for future diminishment of valve-related events. Although the new antithrombin blockers may play a role, the study espoused by García-Rinaldi is most interesting. Our data in this article and in a previously published article in younger patients with no risk factors [3], as well as that of Butchart and colleagues [4] indicate that patient-related risk factors are likely more important than the presence of a mechanical valve prosthesis (particularly aortic) per se in the thromboembolic rate. The trial proposed by García-Rinaldi is a most interesting one, and the outcome will certainly rely on patient selection as those patients with limited risk factors will likely do well on an antiplatelet regimen, whereas those patients with substantive risk factors (both traditional and nontraditional) for thromboembolism will likely not. We look forward to the results of his study. Regarding the issue with death due to myocardial infarction, it is likely that in our elderly population the incidence of sudden unexplained death (ie, a valve-related event) that was undocumented by postmortem was related to coronary artery disease and myocardial infarction rather than a sudden thromboembolic event.

	References

Top References

 

1. García-Rinaldi R. Clopidogrel-aspirin inhibit the thombogenicity of St. Jude mechanical aortic prostheses (letter) Ann Thorac Surg 2006;81:787.[Free Full Text]
2. Emery RW, Krogh CC, Arom KV, et al. The St. Jude Medical cardiac valve prosthesisa 25 year experience with single valve replacement. Ann Thorac Surg 2005;79:776-783.[Abstract/Free Full Text]
3. Emery RW, Erickson CA, Arom KV, et al. Replacement of the aortic valve in patients under 50 years of agelong-term follow-up of the St. Jude Medical prosthesis. Ann Thorac Surg 2003;75:1815-1819.[Abstract/Free Full Text]
4. Butchart EG, Ionescu A, Payne N, Giddings J, Grunkemeier GL, Fraser AG. A new scoring system to determine thromboembolic risk after heart valve replacement Circulation 2003;108(Suppl 1)II-68-74.

This article has been cited by other articles:

				R. W. Emery, A. M. Emery, A. Knutsen, and G. V. Raikar Aortic Valve Replacement with a Mechanical Cardiac Valve Prosthesis Card. Surg. Adult, January 1, 2008; 3(2008): 841 - 856. [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): Robert W. Emery Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Emery, R. W. Articles by Emery, A. M. Search for Related Content PubMed Articles by Emery, R. W. Articles by Emery, A. M. Related Collections Valve disease Related Article