Reply to Nardi et al.

Reply to Nardi et al. Letters to the Editor / European Journal of Cardio-Thoracic Surgery 201 increase at 2–3 years after surgery. They concluded that the risk of early SVD is Department of Cardiology and Thoracic Surgery, Aalborg University high for the Mitroflow prosthesis, especially if the prosthesis is small. Indeed, Hospital, Aalborg, Denmark severe SVD was observed in 44% of patients with prosthesis Size 19 and in Department of Cardiology and Thoracic Surgery, Aarhus University Hospital, 23% of patients with Size 21. In a recently published article, we reviewed 459 Denmark patients undergoing aortic valve replacement using the Mitroflow prosthesis [2]. During a 6-year follow-up period, the incidence of moderate and severe Received 12 March 2018; accepted 12 March 2018 SVD was 12.7% (43 patients) and 4.1% (14 patients), respectively. Although the freedom from SVD was approximately the same in both experiences, we Keywords: Aortic valve replacement � Bioprosthesis � Structural valve observed an increased rate of early degeneration in the presence of patient– deterioration prosthesis mismatch, which was unfortunately common in our series. Overall, the incidence of SVD is higher than that reported for other biological valve prostheses, which are expected to be associated with an SVD rate of less than We thank Nardi et al. [1] for their interest in our recent article [2]and for raising 10% at 10 years [3]. Surprisingly, we faced a new and unexpected problem: the the important and interesting question of the impact of the Mitroflow biopros- more recent DL model, pretreated with octanediol to prevent heterotopic cal- thesis model on occurrence of structural valve degeneration (SVD). In our study, cification of leaflets [4], appeared to deteriorate even earlier in comparison 748 (48%) patients received a Model 12A prosthesis, 708 (46%) a Model LXA with the untreated XL model. We have found that the DL model is a predictor prosthesis and 98 (6%) patients a Model DL. Based on the cross-sectional design of SVD, with a 4-year freedom from moderate SVD and severe SVD of 71 ± 5% of our study and the fact that different models were used in different time periods and 78 ± 6% vs 92 ± 3% and 96 ± 2% in the XL model, respectively. This could with Model 12A used from the start of the study from January 2000 to March be possibly due to a biophysical or biochemical modification induced by the 2006, model LAX thereafter, whereas model DL only was used for the last few so-called PRT process itself. We wonder whether Issa et al. noticed a similar months, the study design is not suited to assess differences in SVD between mod- worse behaviour in the DL or the Crown models. els. However, a reoperation was performed in 40 patients due to SVD prior to the cross-sectional investigation. These patients were treated based on significant SVD and symptoms and, thus, unbiased of the cross-sectional investigation. REFERENCES Median follow-up after aortic valve surgery for Model 12A was 11.0 (interquartile range 9.8–12.1) years when compared with median follow-up of 5.0 (3.0–7.3) [1] Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L et al. years for Model LXA. Given the considerably higher prosthesis age, it was ex- Structural valve deterioration in the Mitroflow biological heart valve pros- pected that numerically more patients with a prosthesis Model 12A underwent a thesis. Eur J Cardiothorac Surg 2018;53:136–42. reoperation (n = 32) when compared with 8 patients with a prosthesis Model [2] Bassano C, Gislao V, Bovio E, Melino S, Tropea I, Saitto G et al. An unex- LXA. Despite this, we found a clear trend that a reoperation for SVD occurred pected risk factor for early structural deterioration of biological aortic valve earlier with Model LXA than Model 12A. prostheses. Ann Thorac Surg 2018;105:521–7. Thus, in agreement with the observation by Nardi et al., our data, with the [3] Johnston DR, Soltesz EG, Vakil N, Rajeswaran J, Roselli EE, Sabik JF 3rd et al. limitation of an overall low number of reoperations, suggest that the risk of Long-term durability of bioprosthetic aortic valves: implications from significant SVD may occur earlier with the more recent model. Unfortunately, 12,569 implants. Ann Thorac Surg 2015;99:1239–47. our data do not allow any insight into the risk of developing SVD with the DL [4] Pettenazzo E, Valente M, Thiene G. Octanediol treatment of glutaraldehyde model. fixed bovine pericardium: evidence of anticalcification efficacy in the sub- cutaneous rat model. Eur J Cardiothorac Surg 2008;34:418–22. * Corresponding author. Cardiac Surgery Unit, Tor Vergata University Hospital, REFERENCES Viale Oxford 81, 00133 Rome, Italy. Tel: +39-06-20903584; fax: +39-06- 20903538; e-mail: pa.nardi4@libero.it (P. Nardi). [1] Nardi P, Bassano C, Pellegrino A, Ruvolo G. Early structural valve deterior- ation of the Mitroflow biological valve prosthesis. Eur J Cardiothorac Surg doi:10.1093/ejcts/ezy136 2018;54:200–1. Advance Access publication 29 March 2018 [2] Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L et al. Structural valve deterioration in the Mitroflow biological heart valve pros- thesis. Eur J Cardiothorac Surg 2018;53:136–42. *Corresponding author. Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense, Denmark. Tel: +45 66113333; e-mail: jacob.moeller1@rsyd.dk (J.E. Møller). a, a b Jacob Eifer Møller *, Issa Farah Issa , Christian Torp Pedersen and Steen Hvitfeldt Poulsen doi:10.1093/ejcts/ezy137 Department of Cardiology and Thoracic Surgery, Odense University Advance Access publication 29 March 2018 Hospital, Odense, Denmark Downloaded from https://academic.oup.com/ejcts/article-abstract/54/1/201/4956400 by Ed 'DeepDyve' Gillespie user on 20 June 2018 LETTERS TO THE EDITOR http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
ISSN
1010-7940
eISSN
1873-734X
D.O.I.
10.1093/ejcts/ezy137
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Abstract

Letters to the Editor / European Journal of Cardio-Thoracic Surgery 201 increase at 2–3 years after surgery. They concluded that the risk of early SVD is Department of Cardiology and Thoracic Surgery, Aalborg University high for the Mitroflow prosthesis, especially if the prosthesis is small. Indeed, Hospital, Aalborg, Denmark severe SVD was observed in 44% of patients with prosthesis Size 19 and in Department of Cardiology and Thoracic Surgery, Aarhus University Hospital, 23% of patients with Size 21. In a recently published article, we reviewed 459 Denmark patients undergoing aortic valve replacement using the Mitroflow prosthesis [2]. During a 6-year follow-up period, the incidence of moderate and severe Received 12 March 2018; accepted 12 March 2018 SVD was 12.7% (43 patients) and 4.1% (14 patients), respectively. Although the freedom from SVD was approximately the same in both experiences, we Keywords: Aortic valve replacement � Bioprosthesis � Structural valve observed an increased rate of early degeneration in the presence of patient– deterioration prosthesis mismatch, which was unfortunately common in our series. Overall, the incidence of SVD is higher than that reported for other biological valve prostheses, which are expected to be associated with an SVD rate of less than We thank Nardi et al. [1] for their interest in our recent article [2]and for raising 10% at 10 years [3]. Surprisingly, we faced a new and unexpected problem: the the important and interesting question of the impact of the Mitroflow biopros- more recent DL model, pretreated with octanediol to prevent heterotopic cal- thesis model on occurrence of structural valve degeneration (SVD). In our study, cification of leaflets [4], appeared to deteriorate even earlier in comparison 748 (48%) patients received a Model 12A prosthesis, 708 (46%) a Model LXA with the untreated XL model. We have found that the DL model is a predictor prosthesis and 98 (6%) patients a Model DL. Based on the cross-sectional design of SVD, with a 4-year freedom from moderate SVD and severe SVD of 71 ± 5% of our study and the fact that different models were used in different time periods and 78 ± 6% vs 92 ± 3% and 96 ± 2% in the XL model, respectively. This could with Model 12A used from the start of the study from January 2000 to March be possibly due to a biophysical or biochemical modification induced by the 2006, model LAX thereafter, whereas model DL only was used for the last few so-called PRT process itself. We wonder whether Issa et al. noticed a similar months, the study design is not suited to assess differences in SVD between mod- worse behaviour in the DL or the Crown models. els. However, a reoperation was performed in 40 patients due to SVD prior to the cross-sectional investigation. These patients were treated based on significant SVD and symptoms and, thus, unbiased of the cross-sectional investigation. REFERENCES Median follow-up after aortic valve surgery for Model 12A was 11.0 (interquartile range 9.8–12.1) years when compared with median follow-up of 5.0 (3.0–7.3) [1] Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L et al. years for Model LXA. Given the considerably higher prosthesis age, it was ex- Structural valve deterioration in the Mitroflow biological heart valve pros- pected that numerically more patients with a prosthesis Model 12A underwent a thesis. Eur J Cardiothorac Surg 2018;53:136–42. reoperation (n = 32) when compared with 8 patients with a prosthesis Model [2] Bassano C, Gislao V, Bovio E, Melino S, Tropea I, Saitto G et al. An unex- LXA. Despite this, we found a clear trend that a reoperation for SVD occurred pected risk factor for early structural deterioration of biological aortic valve earlier with Model LXA than Model 12A. prostheses. Ann Thorac Surg 2018;105:521–7. Thus, in agreement with the observation by Nardi et al., our data, with the [3] Johnston DR, Soltesz EG, Vakil N, Rajeswaran J, Roselli EE, Sabik JF 3rd et al. limitation of an overall low number of reoperations, suggest that the risk of Long-term durability of bioprosthetic aortic valves: implications from significant SVD may occur earlier with the more recent model. Unfortunately, 12,569 implants. Ann Thorac Surg 2015;99:1239–47. our data do not allow any insight into the risk of developing SVD with the DL [4] Pettenazzo E, Valente M, Thiene G. Octanediol treatment of glutaraldehyde model. fixed bovine pericardium: evidence of anticalcification efficacy in the sub- cutaneous rat model. Eur J Cardiothorac Surg 2008;34:418–22. * Corresponding author. Cardiac Surgery Unit, Tor Vergata University Hospital, REFERENCES Viale Oxford 81, 00133 Rome, Italy. Tel: +39-06-20903584; fax: +39-06- 20903538; e-mail: pa.nardi4@libero.it (P. Nardi). [1] Nardi P, Bassano C, Pellegrino A, Ruvolo G. Early structural valve deterior- ation of the Mitroflow biological valve prosthesis. Eur J Cardiothorac Surg doi:10.1093/ejcts/ezy136 2018;54:200–1. Advance Access publication 29 March 2018 [2] Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L et al. Structural valve deterioration in the Mitroflow biological heart valve pros- thesis. Eur J Cardiothorac Surg 2018;53:136–42. *Corresponding author. Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense, Denmark. Tel: +45 66113333; e-mail: jacob.moeller1@rsyd.dk (J.E. Møller). a, a b Jacob Eifer Møller *, Issa Farah Issa , Christian Torp Pedersen and Steen Hvitfeldt Poulsen doi:10.1093/ejcts/ezy137 Department of Cardiology and Thoracic Surgery, Odense University Advance Access publication 29 March 2018 Hospital, Odense, Denmark Downloaded from https://academic.oup.com/ejcts/article-abstract/54/1/201/4956400 by Ed 'DeepDyve' Gillespie user on 20 June 2018 LETTERS TO THE EDITOR

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Mar 29, 2018

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