J Thorac Cardiovasc Surg 2008;136:1103
© 2008 The American Association for Thoracic Surgery
Reply to the Editor:
W. Flameng, MD, PhD
Cardiac Surgery, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
I thank Szentkirályi, Péterffy, and Galajda for their interest in our study on the durability of mitral valve repair in Barlow disease. The point they try to make in their letter is that mitral annuloplasty in myxoid mitral valve degeneration does not necessarily have to be a ring annuloplasty. This might be correct; who knows?
The problem is that, nowadays, when you make a statement, hard data are required to convince the medical and scientific community to agree with you. In our study on the recurrence of mitral valve regurgitation after successful repair of Barlow disease and fibroelastic degeneration, we presented and analyzed extensive preoperative, intraoperative, and postoperative data, including long-term echocardiographic follow up. In our study, patients received either a ring annuloplasty or no annuloplasty at all. We did not study any other form of annuloplasty, and therefore it would not be correct to draw such a general conclusion as, "Lack of stabilization of the mitral annulus increases the risk of recurrent mitral valve regurgitation." To advocate this statement, one should test every possible form of annuloplasty and compare them all with no annuloplasty. In their own experience, Szentkirályi, Péterffy, and Galajda mention that some materials used for suture annuloplasty, such as polypropylene and polyester sutures, cause recurrent regurgitation. Is this not why the annuloplasty ring was developed?
Before we conclude that "Lack of stabilization of the mitral annulus increases the risk of recurrent mitral valve regurgitation," I invite Szentkirályi, Péterffy, and Galajda to analyze their data on suture annuloplasty in a scientific way and compare them with results of repair procedures without annuloplasty, rather than relying on their own experience, even with several hundred patients. I am well aware of the importance of personal experiences of renowned surgeons such as our Hungarian colleagues, and I appreciate the opportunity to share these experiences. Before introducing a concept into current praxis, however, I prefer data-based, scientific proof.
