J Thorac Cardiovasc Surg 2009;138:863-864
© 2009 The American Association for Thoracic Surgery
Discussion
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Dr Lars G. Svensson
(Cleveland, Ohio). Dr David, congratulations on your excellent results in developing these operations, and thank you again for personally teaching me the reimplantation operation.
We have had similar results with 234 patients, of whom 78 had Marfan syndrome, 9 had Loeys–Dietz syndrome, and 5 had Ehlers–Danlos syndrome, and no deaths have occurred using our modification of the David reimplantation operation. Like you, we have also become more aggressive in repairing leaflets, with 35% being repaired in the last year. Indeed, in our own analysis all our patients have had a freedom from reoperation, like yours, of 96% at 9 years, with no failures in the Marfan reimplantation reoperations. However, like you, we have reported in the Annals a higher failure rate for the remodeling operation, which leads to my first question. Do you not think we now have enough information, including your greater experience, to say that the remodeling operation should be abandoned and that the David reimplantation operation is the standard of care for connective tissue disorders, when feasible?
My second question relates to the reimplantation operation and the . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
