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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): Paul H. Schoof Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schoof, P. H. Search for Related Content PubMed Articles by Schoof, P. H. Related Collections Cardiac - other Valve disease

J Thorac Cardiovasc Surg 2008;136:231
© 2008 The American Association for Thoracic Surgery

Letter to the Editor

Stentless valve dehiscence

Department of Cardiothoracic Surgery, University Medical Center St Radboud, Nijmegen, The Netherlands

To the Editor:

With great interest we read the article by Richard Hopkins and colleagues¹ on their patient who experienced dehiscence of the preserved noncoronary sinus after subcoronary allograft replacement of the aortic valve. The authors write that this complication might not be unique for this method of allograft implantation and that it could in fact occur with any type of inclusion technique, as long as sinuses are retained. They also suggest that some methods of insertion of stentless xenograft valves could also be liable to this complication.

We can confirm that dehiscence of the stentless xenograft indeed occurs and that it has a strong predilection for the noncoronary sinus. In 10 of 168 patients, partial dehiscence was found 4 to 49 months after subcoronary implantation of a stentless xenograft with preserved noncoronary sinus.² In contrast to the reported patient, our patients all received diagnoses relatively early and all underwent reoperations for present or feared valve dysfunction. The mechanism, however, seems similar. Supposedly, proteolytic enzymes from captured blood cells in the dead space between native and donor aortas might prevent adequate fusion of the walls and healing of the anastomosis.

The assumption that this particular problem is related to the concept of coronary sinus inclusion seems very likely, and closure of the dead space might be important when this particular technique is used.

References

1. Hopkins R, Gitter H, Stave J, Bert A, Atalay M. Stable partial dehiscence of aortic homograft inserted freehand by using the subcoronary intra-aortic root noncoronary sinus Ross scallop inclusion technique. J Thorac Cardiovasc Surg 2008;135:214-216.[Free Full Text]
   
2. Schoof P, Baur L, Kappetein A, Hazekamp M, vanRijk-Zwikker G, Huysmans H. Dehiscence of the Freestyle stentless bioprosthesis. Semin Thorac Cardiovasc Surg 1999;11(suppl 1):133-138.[Medline]
   

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): Paul H. Schoof Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schoof, P. H. Search for Related Content PubMed Articles by Schoof, P. H. Related Collections Cardiac - other Valve disease