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Valves: Dimitrios Buklas, Massimo Massetti, Eugenio Neri, and Sidney Chocron Built-in defect of a biological pericardial aortic prosthesis? Interactive CardioVascular and Thoracic Surgery published on Jun 12, 2008 as doi:10.1510/icvts.2008.180448 [Abstract] [Journal Format PDF]

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eComment. Early postoperative failure of a pericardial aortic prosthesis

Can C. Erdem   (13 August 2008)

eComment. Early postoperative failure of a pericardial aortic prosthesis 13 August 2008
Can C. Erdem Mayo Clinic Rochester, 200 First St SW, Rochester MN 55902, USA Send ecomment to journal: Re: eComment. Early postoperative failure of a pericardial aortic prosthesis erdem.can{at}mayo.edu Can C. Erdem	Interactive CardioVascular and Thoracic Surgery 2008, doi:10.1510/icvts.2008.180448A © 2008 European Association of Cardio-Thoracic Surgery As the authors herein have stated, the structural abnormalities of bovine pericardial prosthesis resulting in an immediate postoperative failure are very rare (~0.1%) [1]. It seems to be obvious though that one of those rare instances has happened in their practice. As a consequence of what they have mentioned in their paper, I have a couple of things to ask to the authors. First of all, have they initially closely inspected or noticed that crease on the non-coronary leaflet of the prosthesis in the first operation? I imagine their answer will be "no" to this question but then in the reoperation they have mentioned that when they opened the aortic vascular graft the prosthesis appeared intact with no macroscopic alterations. According to what they have said in their paper, it was not until the laboratory studies were completed that they were aware of that fold, in opposition to what is perceived in their Figure 1 which is an immediate postoperative view of the initial prosthesis. In any case, having witnessed this rare situation, what has prompted the authors to re-replace the prosthesis with the same type and brand of prosthetic valve? Secondly, if they have used pledgeted sutures in the first operation, did they have any difficulty in retrieving those pledgets in the reoperation and what technique have they used to catch them before they fall back in the left ventricular cavity? Finally, would this unlucky occasion be a milestone in their preference to not routinely perform an intraoperative transesophageal echocardiogram in their aortic valve replacement group of patients, especially in those with calcific aortic stenosis and dense annular calcifications where an insufficient debridement will more than likely result in a small paravalvular leak which may not be that apparent when grossly looking at the ventricle following discontinuation of cardiopulmonary bypass or looking at the pulse pressure on the monitor. I would like to congratulate the authors on their work and presentation. Reference [1] Buklas D, Massetti M, Neri E, Chocron S. Built-in defect of a biological pericardial aortic prosthesis? Interact CardioVasc Thorac Surg doi:10.1510/icvts.2008.180448.