J Thorac Cardiovasc Surg 2008;136:231
© 2008 The American Association for Thoracic Surgery
Reply to the Editor:
Richard A. Hopkins, MD
Department of Cardiac Surgery, Children's Mercy Hospital, Kansas City, Mo
We appreciate Professor Schoof and his colleagues for confirming our observations concerning the technical predilections for this complication. We use the stentless xenograft as an aortic root replacement, and therefore we have no experience with techniques liable to this complication, except historically with homografts. The 6% incidence in their series with an inclusion technique retaining 1 or more sinuses is indeed concerning. We concur that meticulous attention to closure of the dead space between the native and implanted sinus walls is critical. When we were using the "scallop" technique, we did use obliterating sutures, which clearly did not obviate this single occurrence. We can only speculate about the potential usefulness of biologic glues to enhance fusion of the walls. In contrast to their 100% reoperation rate, our single case report was also written to make the point that in the absence of valve dysfunction, progressive dehiscence, or the development of thrombus, conservative management appears to be safe with antiplatelet therapy and consistent yearly imaging follow-up.
