European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR RESPONSE postoperative haemodynamics, and thus, larger-sized bileaﬂet mechanical valves are often used to reduce the risk of PPM. Ozyalcin et al.  in their 2 2 study concluded that an in vivo effective oriﬁce area index (EOAI) <1.19 cm /m Ganesh Kumar K. Ammannaya* strongly suggests a suboptimal haemodynamic recovery following MVR with the Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak bileaﬂet mechanical prosthesis and observed that although no direct relation- Municipal Medical College and General Hospital, Mumbai, India ship between prosthesis size and in vivo EOAI was demonstrated, the logical approach is to implant a prosthesis of the largest possible size. Received 25 March 2018; accepted 26 March 2018 We also keenly await the completion of the study by Totaro and Pelenghi  about their ONy-X ‘one size ﬁts all’ prosthesis to get further insights on the Keywords: Mitral valve replacement (MVR) � Prosthesis patient mismatch issue of mitral PPM. (PPM) � Pulmonary hypertension � Effective oriﬁce area (EOA) REFERENCES I thank Totaro and Pelenghi [1, 2] for their valuable comments on our article. It is indeed a great privilege to have such vastly experienced and distinguished  Totaro P, Pelenghi S. Patient-prosthesis mismatch after mitral valve re- colleagues take interest in our study. placement: complex enigma with more than one solution. Eur J Totaro and Argano showed in their study that the predicted risk of mitral Cardiothorac Surg 2018; doi:10.1093/ejcts/ezy163. prosthesis patient mismatch (PPM), based on in vitro measurement, signiﬁ-  Ammannaya GKK, Mishra P, Khandekar JV, Mohapatra CHR, Seth HS, cantly exceeds the real risk of PPM after mitral valve replacement (MVR), even Raut C et al. Effect of prosthesis patient mismatch in mitral position on when small-sized bioprostheses are used. They also attempted to drive home pulmonary hypertension. Ann Cardiothorac Surg 2017;6:193–1174. the point that residual pulmonary hypertension did not correlate with the size  Totaro P, Argano V. Patient-prosthesis mismatch after mitral valve re- of prosthesis or postoperative PPM. The reservation one could have with the placement: myth or reality? J Thorac Cardiovasc Surg 2007;134:697–701. aforementioned study is that it was a rather small subset of 146 patients with  Cho I-J, Hong G-R, Lee SH, Chang SB-C, Shim CY, Chang H-J et al. just 8 patients having PPM and also a very limited follow-up of 1 month, with Prosthesis-patient mismatch after mitral valve replacement: comparison the implantation of bioprosthetic valves alone . In contrast, our study had a of different methods of effective oriﬁce area calculation. Yonsei Med J long mean follow-up period of 8.15 ± 3.2 years, and we believe that the ad- 2016;57:328–36. verse effect of PPM on pulmonary arterial pressure would need a longer fol-  Cao H, Qiu Z, Chen L, Chen D, Chen Q. Star GK bileaﬂet mechanical low-up time. Further, following propensity matching, we compared 112 pairs valve prosthesis-patient mismatch after mitral valve replacement: a of PPM and no PPM cohorts. However, our study included only mechanical Chinese Multicenter Clinical Study. Med Sci Monit 2015;21:2542–6. valves .  Ozyalcin S, Vural KM, Colak A. Mitral patient-prosthesis mismatch pre- I fully agree with Totaro and Argano that a homogenous method of haemo- dicts suboptimal hemodynamic recovery after mitral valve replacement. dynamic performance evaluation is the ﬁrst step towards a better understanding J Heart Valve Dis 2016;25:589–95. of the real risk of mitral PPM. Both our studies have used the continuity equa- tion method for the calculation of effective oriﬁce area (EOA), which has been ascertained by Cho et al.  as the only predictor of postoperative haemo- *Corresponding author. Department of Cardiovascular and Thoracic Surgery, dynamic parameters. Our study is indeed one of the ﬁrst large studies compris- Lokmanya Tilak Municipal Medical College and General Hospital, Sion, ing 500 patients, which included the continuity equation for the determination Mumbai 400022, India. Tel: +919900409207; e-mail:doc.ammannaya@gmail. of EOA. com (G.K.K. Ammannaya) Two recent studies by Cao et al. and Ozyalcin et al. that concurred with our ﬁndings also incorporated the continuity equation. Cao et al. in a doi:10.1093/ejcts/ezy164 multicentric clinical study showed that PPM after MVR inﬂuences The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Downloaded from https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy164/4978198 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Apr 19, 2018
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