J Thorac Cardiovasc Surg 2006;131:761
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
Eivind Øvrum, MD, PhD,
Geir Tangen, MD
Oslo Heart Center, National Hospital, Oslo, Norway
We appreciate the interest in our brief report1 regarding acute leaflet arrest in the St Jude Medical (SJM) Regent aortic valve (St Jude Medical, Inc, St Paul, Minn). The remarks forwarded by Dr Emery clearly indicate that specific precautions must be taken regarding the technique of implantation. His figure 1 demonstrates the shorter distance from the subvalvular tissue to the hinges. He proposes everting mattress sutures for inserting all the types of SJM valves, and this is certainly a safe technique. However, we are not convinced that this is the most common procedure for implantation of supra-annular prostheses. To our knowledge, the most preferred technique is ventricular-to-aortic sutures for supra-annular valves, to optimize the orifice area.
These circumstances were the main reason for our publication. We used standard and widely recognized suture techniques for aortic valve replacement, and severe technical problems occurred with the SJM Regent valve. The reported cases were routine operations without any particular difficulties from the patient's side. After the valve was tied down, the leaflets were unmovable and rotation was impossible, due to entrapment of the subvalvular tissue into the hinges. The operations were performed by senior cardiac surgeons, having implanted a large number of several types of aortic valve prostheses during more than 25 years. The situation was most unpleasant, particularly considering the potential risk of pledget escape when cutting the sutures for removal of the valve. All patients had an uneventful recovery after a prolonged operation for rereplacement. However, similar negative experience has not been published with other valves, and therefore we wanted to share our experience with other surgeon colleagues.
We do not believe that oversizing was the case in any of the patients. They were all adult male patients with normal size of the aortic ostia and candidates for 25-mm to 27-mm valves. If the SJM Regent valve has to be downsized on routine basis, the hemodymamic advantages must, at least partly, be abolished.
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- 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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