Ann Thorac Surg 2006;82:541
© 2006 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Robert W. Emery, MD,
Goya V. Raikar, MD,
Ann M. Emery, RN
Department of CV Surgery, Regions Hospital, 2356 University Ave W, Suite 258, St. Paul, MN 55114
(Email: dremery{at}csa-heart.com).
Eichinger and colleagues [1] carefully document intermittent, incomplete closure of one leaflet of the Advantage heart valve, resulting in intermittent regurgitation with associated diastolic pressure drop. This phenomenon has not been noted in other bileaflet prostheses, is not related to orientation, can be in either leaflet, and occurs in the aortic position. Limited correspondence indicates that due to one such finding, a valve was replaced with a second Advantage valve and the same phenomenon replicated. In the utilization of mechanical heart valves, durability is paramount. The disadvantages of long-term anticoagulation must be offset by a prosthesis that stands the test of time. It is unknown whether the current reported finding is due to a deficit in the valve itself or patient condition, and there is no apparent indication for valve replacement because no complications have been reported. Leaflet embolization led to the discontinuation of a tilting disc prosthesis, and paravalvular leak to the discontinuation of a silver impregnated sewing ring with other mechanical prostheses.
There is no current evidence of an increased incidence of untoward events with this prosthesis, but careful follow-up is necessary, and further contributions to the literature should be sought regarding patient outcome. A better definition of this phenomenon is warranted.
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References
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- Eichinger WB, Wagner IM, Bleiziffer S, et al. Occasional single beat regurgitation observed with the Medtronic Advantage bileaflet heart valve Ann Thorac Surg 2006;82:537-541.[Abstract/Free Full Text]
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