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J Thorac Cardiovasc Surg 2004;127:1852-1854
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Eugene H. Blackstone, MD, A. Marc Gillinov, MD, Delos M. Cosgrove, MD

Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA

The first 20% of the full text of this article appears below.

Reply to the Editor:

We have long respected the excellent and prolific work of Dumesnil and Pibarot, so it is not surprising that we referred to their publications in our articles. However, they are unhappy in part with the way we have interpreted (or misinterpreted) their work,1,2 and in part with the surgical recommendations we based on survival data from our multicenter meta-analysis,1 which differ from their own, which were based largely on functional prosthesis performance data.


   What we studied
 
Survival
We studied the relation of geometric prosthesis size to time-related survival with nine sources of data and nearly 70,000 patient-years of follow-up among 13,258 patients who underwent aortic valve replacement with mechanical prostheses, stent-mounted bioprostheses, and allografts at multiple institutions on two continents.1

Long-term survival is a relevant and important goal of aortic valve replacement,3 although how it is associated with efficiency of prosthetic devices remains controversial. Use of small label-size prostheses has been presumed by many surgeons to reduce survival after valve replacement. When patients were stratified by label size in our large study, however, prosthesis size was found to have little impact on survival (in contrast to substantial impact of patient factors, such as age). Unlike all previous studies, ours had the statistical power to detect even small differences in survival, with 1109 prostheses of label size 19 mm or smaller and 2984 of label size 21 mm.

To increase sensitivity, we focused our survival analysis on the geometric dimension of the internal orifice of the prosthesis normalized to patient size (prosthesis-patient size), . . . [Full Text of this Article]


Related Article

Prosthesis size and prosthesis-patient size are unrelated to prosthesis-patient mismatch
Jean G. Dumesnil and Philippe Pibarot
J. Thorac. Cardiovasc. Surg. 2004 127: 1852. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 CirculationHome page
P. Pibarot, J. G. Dumesnil, G. Tasca, C. G. Koch, F. Khandwala, F. G. Estafanous, F. D. Loop, and E. H. Blackstone
Letter Regarding Article by Koch et al, "Impact of Prothesis-Patient Size on Functional Recovery After Aortic Valve Replacement" * Response
Circulation, November 22, 2005; 112(21): e333 - e333.
[Full Text] [PDF]


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