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J Thorac Cardiovasc Surg 2007;133:1002-1003
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Aubrey C. Galloway, Jr (New York, NY). This was a very nice presentation, and I congratulate you on doing a randomized trial, which we have too often been unable to do in this country. I do have some comments and questions.

The first comment is that this study includes a mixed group of patients, which limits your ability to draw conclusions. Although 66% of the patients had degenerative disease, 10% were rheumatic, and 10% had ischemic or dilated cardiomyopathy. The latter group really has a different mechanism for insufficiency than the degenerative patients, and they consequently have a different mechanism for late repair failure. These 2 groups really need to be evaluated separately.

For example, the patients with ischemic or dilated cardiomyopathy and functional MR had roughly a 25% failure rate for reoperation at 5 to 8 years. Did you see a difference in the rigid versus flexible rings in that group? Others have found that patients with ischemic or dilated cardiomyopathy have better results when rigid or semirigid devices are used.

Second, even when you looked at the overall freedom from reoperation and included all of the patients, there was roughly a 10% difference favoring the rigid group. Likewise, when you looked at freedom from recurrent 3 or 4+ MR, there was a difference favoring the rigid ring group, yet these differences were not statistically significant. Unfortunately, the study is underpowered to detect small . . . [Full Text of this Article]

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