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J Thorac Cardiovasc Surg 2006;131:760
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Oslo Heart Center, National Hospital, Oslo, Norway

We appreciate the remarks forwarded by Dr Gerosa. However, we believe that their comments strengthened the concerns we pointed out in our brief communication. ¹ For implantation of the St Jude Medical (SJM) Regent aortic valve (St Jude Medical, Inc, St Paul, Minn), they describe a modified technique, using tourniquets to pull down the valve before tiding. This kind of maneuver is normally not necessary when inserting supravalvular prostheses provided by other manufactures.

The main message of our report was that, being presented with a new modification of the SJM valve, we encountered technical problems in routine valve replacement operations, using standard, widely recognized suture techniques. In the cases presented, the leaflets were unmovable and rotation was impossible due to entrapment of the subvalvular tissue into the hinge. Whether or not the term "acute leaflet arrest" is correct remains a minor issue; the situation was unexpected and very unpleasant. The operations were performed by senior cardiac surgeons who had implanted a large number of several types of aortic valve prostheses during more than 25 years. Further, since publishing our negative results, other colleagues have confidentially reported anecdotal cases similar to ours.

In contrast to other prostheses that can be implanted entirely above the ring, the hinges of the SJM Regent valve are still placed below the annulus. Consequently, this valve cannot be regarded as a true supra-annular valve. Therefore, we find the statement in the first line of Gerosa's letter, claiming that the SJM Regent valve "represents the ultimate step in bileaflet valve engineering," difficult to accept.

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1. Øvrum E, Tangen G. Acute leaflet arrest in St. Jude Medical Regent aortic valve. J Thorac Cardiovasc Surg 2005;129:1446.[Free Full Text]
   

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This Article 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 Author home page(s): Eivind Øvrum Geir Tangen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Øvrum, E. Articles by Tangen, G. Search for Related Content PubMed Articles by Øvrum, E. Articles by Tangen, G. Related Collections Valve disease Related Article