HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content

J Thorac Cardiovasc Surg 2008;136:1205-1206
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr David Adams (New York, NY). Volkmar, I enjoyed your talk, as always. I think we all continue to learn a lot from your efforts at Leipzig in refining surgical valve strategies, particularly in the non-sternotomy setting, and this article is no exception. The fact that this was a randomized prospective MV repair trial is no small feat. Your 100% repair rate with excellent postoperative results in a consecutive series regardless of technique is a standard we should all aspire to. I think the most important aspect of this study is the emphasis on nonresective strategy, which is particularly relevant, as you showed, in the setting of fibroelastic deficiency with ruptured chordae and normal leaflet segment. I think there is a lot of misunderstanding regarding Carpentier's techniques, and I would emphasize that an overly aggressive resection is a pitfall that should be avoided. I do have some specific questions regarding your study.

First, can you clarify the extent of your quadrangular resection in the resection group? Was the entire prolapsing segment always removed or did you limit your resection to the area of prolapse between intact chords?

Dr Falk. We usually resect the complete P2 segment and do a quadrangular resection, which is completed by a sliding plasty or at least compression or plication sutures.

Dr Adams. One point I would make is oftentimes when you do that you remove nonprolapsing tissue that would be effective for your surface of coaptation. Again, a technique I learned from Dr Carpentier is that typically it is to preserve part of this P2 segment if it is nonprolapsing, and that may be one reason why you are seeing a difference.

The second question was how did you handle a deep indentation between adjacent leaflet segments associated with P2 prolapse in the loop . . . [Full Text of this Article]