ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;88:710. doi:10.1016/j.athoracsur.2009.04.056
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Mariano Vicchio
Alessandro Della Corte
Marisa De Feo
Maurizio Cotrufo
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vicchio, M.
Right arrow Articles by Cotrufo, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Vicchio, M.
Right arrow Articles by Cotrufo, M.
Related Collections
Right arrowRelated Article

Correspondence

Reply

Mariano Vicchio, MD, PhD, Alessandro Della Corte, MD, PhD, Marisa De Feo, MD, PhD, Maurizio Cotrufo, MD

Department of Cardiothoracic Sciences, Second University of Naples, Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Via Cassano 150, Naples, 80144 Italy

(Email: marianovicchio{at}libero.it).

To the Editor:

We read with interest the letter by Gasparovic [1] regarding the issue of prosthesis patient mismatch (PPM) in elderly patients. We have long studied mechanical prosthesis implants in the elderly [2–4].

We are not reluctant to use biological valves as Gasparovic [1] states, but we have developed our institutional policy for more frequent use of mechanical valves because of our successful management of anticoagulation in elderly people [5].

Gasparovic [1] alleges that we have "emphasized the greater durability of mechanical prosthesis in comparison to tissue valves" but our study was not a comparative analysis. Our study focused on satisfactory hemodynamic performance of small-sized mechanical valves in the elderly, on the irrelevance of PPM to long-term mortality, the incidence of valve-related complications, and the quality of life.

We reported that in our study population the PPM did not reduce survival and quality of life. Considering the increased life expectancy in the world and the safety of anticoagulation in the elderly, mechanical valve implantation could reduce the risk of reoperation in elderly patients with bioprosthetic structural degeneration. When asked to choose a valve substitute, our elderly patients are generally more threatened by a possible reoperation than by possible anticoagulation-related complications that can be avoided by close follow-up.

Most authors alleged that oral anticoagulation in the elderly has a high risk of hemorrhagic events.

Others maintain that monitoring anticoagulation reduces the quality of life. In our studies, we have shown that freedom from hemorrhagic complications is 98.3% ± 0.007 at 10 and 15 years [5, 6]. Moreover, quality-of-life scores are more than satisfying.

Gasparovic [1] mentioned transcatheter valve-in-valve prosthesis procedures and cited an article on 40 patients with a mean follow-up of 144 days and hospital mortality of 17.5%. Although those promising procedures need further assessment in the long term and in larger cohorts, our patient population antedated those innovations.

We believe that the reliability of new, less invasive procedures for the elderly or high-risk patients should always be compared with traditional series like ours.


   References
Top
 References
 

  1. Gasparovic H. Prosthesis-patient mismatch in the elderly (letter) Ann Thorac Surg 2009;88:709-710.[Free Full Text]
  2. Vicchio M, De Santo LS, Della Corte A. Aortic valve replacement with 19-mm bileaflet prostheses in the elderly: left ventricular mass regression and quality of life J Heart Valve Dis 2008;17:216-221.[Medline]
  3. Vicchio M, Della Corte A, De Santo LS, et al. Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life Ann Thorac Surg 2008;86:1791-1797.[Abstract/Free Full Text]
  4. De Feo M, Onorati F, Renzulli A, et al. Mechanical valve prosthesis is a valid option for aortic valve replacement in the elderly J Heart Valve Dis 2004;13:103-108.[Medline]
  5. Vicchio M, Della Corte A, De Feo M, et al. Quality of life after implantation of bileaflet prostheses in elderly patients: an anticoagulation work group experience Ann Thorac Surg 2007;84:459-465.[Abstract/Free Full Text]
  6. Vicchio M, Della Corte A, De Santo LS, et al. Tissue versus mechanical prostheses: quality of life in octogenarians Ann Thorac Surg 2008;85:1290-1295.[Abstract/Free Full Text]

Related Article

Prosthesis-Patient Mismatch in the Elderly
Hrvoje Gasparovic
Ann. Thorac. Surg. 2009 88: 709-710. [Extract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Mariano Vicchio
Alessandro Della Corte
Marisa De Feo
Maurizio Cotrufo
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vicchio, M.
Right arrow Articles by Cotrufo, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Vicchio, M.
Right arrow Articles by Cotrufo, M.
Related Collections
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS