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J Thorac Cardiovasc Surg 2007;134:97-98
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Glen Van Arsdell (Toronto, Ontario, Canada). Dr Caldarone, my partner, was the invited commentator. He was unable to be here. I am providing what are essentially his comments.

This is an impressive report describing TCE for bicuspid aortic valves compared with the Ross procedure. The results have been analyzed with an appropriate degree of caution, recognizing the variable nature of outcomes with leaflet extension.

The hallmark of a good operation is one that is easily reproduced and produces consistent results. In this respect, I think that at the Hospital for Sick Children we are still in a development phase with the leaflet extension technique. We have some difficulty verbalizing why some valves simply do not appear to be repairable. We know them when we see them, but cannot always say why. And when we do repair a valve, we have difficulty determining what technical details lead some to develop progressive insufficiency while others do not.

The solution for this dilemma is the development of a finer vocabulary describing the anatomy of the valve disease and better description of the components of the procedure performed. With a better vocabulary we can develop more consistency in our techniques and move the leaflet extension technique from an artistic operation to a more consistent, reproducible, and durable procedure.

Along the lines of better description of the problems, my questions are as follows:

The bicuspid aortic valve represents a spectrum of development from a well-developed but fused commissure to a nearly absent rudimentary raphe. One would anticipate better results with tricuspidization in the presence of a well-developed but fused commissure. Are you able to comment on the degree of development of the fused commissure and the impact that this had on your intraoperative decision-making, as well as the durability of the subsequent repair?

Dr . . . [Full Text of this Article]

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