Reply to Totaro and Pelenghi

Reply to Totaro and Pelenghi 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. [6] 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 [1] 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 [1] 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- [2] 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 [3] 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 [4] 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 [3]. 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- [5] 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 [2]. [6] 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. [4] 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.[5] and Ozyalcin et al.[6] that concurred with our findings also incorporated the continuity equation. Cao et al. [5]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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Reply to Totaro and Pelenghi

Free
1 page

Loading next page...
1 Page
 
/lp/ou_press/reply-to-totaro-and-pelenghi-ZwoO0Cmsu1
Publisher
Oxford University Press
Copyright
© 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/ezy164
Publisher site
See Article on Publisher Site

Abstract

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. [6] 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 [1] 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 [1] 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- [2] 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 [3] 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 [4] 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 [3]. 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- [5] 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 [2]. [6] 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. [4] 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.[5] and Ozyalcin et al.[6] that concurred with our findings also incorporated the continuity equation. Cao et al. [5]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

Journal

European Journal of Cardio-Thoracic SurgeryOxford University Press

Published: Apr 19, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off