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Ann Thorac Surg 2006;81:2339-2340
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

The Cleveland Clinic Foundation, Desk F24, 9500 Euclid Cleveland, OH 44195

(Email: gillinom{at}ccf.org).

To the Editor:

We thank Drs Dreyfus and Aubert [1] for their comments concerning our article on commissural closure for repair of mitral commissural prolapse [2]. Recently there has been a great interest in the development of new surgical and percutaneous techniques for the management of heart valve disease [3]. Although some of these new procedures are completely novel, many represent modifications of existing techniques. We believe that commissural closure and annuloplasty falls into the latter category. Nevertheless, we agree with Dreyfus and Aubert [1] that new approaches require validation by collection of both early and long-term results.

In the case of commissural closure with annuloplasty, early and mid-term results are encouraging. We and other authors [4] have observed excellent durability. We have measured transvalvular gradients in all patients operated upon at The Cleveland Clinic Foundation, and we have not identified any patient with mitral stenosis; this is not surprising, given the pliability of leaflet tissue in patients with degenerative disease. We will continue to monitor these patients to obtain long-term data assessing repair durability.

We find this technique attractive because of its simplicity. Using other procedures, management of prolapse at a commissure can be challenging. Although authors have described papillary muscle repositioning to treat this sort of pathophysiology [5], most surgeons have limited experience with manipulation of the subvalvular apparatus. As with other mitral repair procedures, commissural closure incorporates an annuloplasty, and this should optimize repair durability.

It is appropriate to scrutinize new approaches to heart valve disease. Many novel procedures, such as percutaneous aortic valve replacement, challenge fundamental surgical concepts (eg, the native valve must be excised before a prosthesis is inserted). At this point in the evolution of the treatment of heart valve disease, it is incumbent upon surgeons to examine new therapies with an open mind and to apply standard outcome measures and analysis before rendering judgment on the success of new approaches.

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1. Dreyfus G, Auber S. Should mitral valve prolapse, even though commissural, be treated by suturing both leaflets together? Ann Thorac Surg 2006;81:2339.[Free Full Text]
2. Gillinov AM, Shortt KG, Cosgrove DM. Commissural closure for repair of mitral commissural prolapse Ann Thorac Surg 2005;80:1135-1136.[Abstract/Free Full Text]
3. Vassiliades TA, Block PC, Cohn LH, et al. The clinical development of percutaneous heart valve technology Ann Thorac Surg 2005;79:1812-1818.[Free Full Text]
4. Maisano F, Caldarola A, Blasio A, De Bonis M, La Canna G, Alfieri O. Midterm results of edge-to-edge mitral valve repair without annuloplasty J Thorac Cardiovasc Surg 2003;126:1987-1997.[Abstract/Free Full Text]
5. Dreyfus GD, Bahrami T, Alayle N, Mihealainu S, Dubois C, de Lentdecker P. Repair of anterior leaflet prolapse by papillary muscle repositioninga new surgical option. Ann Thorac Surg 2001;71:1464-1470.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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): Delos M. Cosgrove, III Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gillinov, A. M. Articles by Cosgrove, D. M. Search for Related Content PubMed Articles by Gillinov, A. M. Articles by Cosgrove, D. M., III Related Collections Valve disease Related Article