Ann Thorac Surg 2007;84:514
© 2007 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited commentary
Craig R. Smith, MD
Department of Cardiothoracic Surgery, Columbia University Medical Center, Milstein Hospital Bldg 7-435, 177 Fort Washington Ave, New York, NY 10032
(Email: crs2{at}columbia.edu).
The authors [1] have shown that passive containment does not influence reverse remodeling or left ventricular ejection fraction after aortic valve replacement for aortic regurgitation. Aortic regurgitation produces both a pressure overload and a volume overload on the ventricle in contrast with the pure volume overload seen in mitral regurgitation. As the authors mentioned, this might explain why results were different in the series reported by Acker and colleagues (see reference 5). The authors also consider whether passive containment might have detrimental effects on right ventricular function and do not successfully dismiss this concern. Readers should keep this possibility in mind.
As acknowledged by the authors, this is a very small series. Some readers may believe that studies supporting a null hypothesis require large numbers to increase our confidence in the conclusions, and that this study is too small to provide it. Although this is an appealing notion, publication of this article is an important counterbalance to the authors’ enthusiastic 2005 case report (see reference 6) describing remarkable improvement in a single patient.
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References
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- Bredin F, Olsson A, Franco-Cereceda A. No additive effect of passive containment surgery in patients with aortic regurgitation and left ventricular dilation Ann Thorac Surg 2007;84:510-514.[Abstract/Free Full Text]
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