Invited Commentary

Abstract

In this article, Pektok and colleagues [1Pektok E. Sierra J. Cikirikcioglu M. Müller H. Myers P.O. Kalangos A. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis.Ann Thorac Surg. 2010; 89: 1180-1186Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar] report their evaluation of the use of a biodegradable annuloplasty ring concomitant with valve repair in patients with infected endocarditis. This article is interesting because it is a new concept with theoretic advantages. I believe that this report is of interest to the readers of the Annals of Thoracic Surgery, and the use of biodegradable ring may alter the current management of infected endocarditis. I agree with their assertion that it is preferable to avoid any foreign material in the contaminated field. The annuloplasty ring is a biodegradable polymer called poly-1,4-dioxanone. The biodegradable polymer apparently degraded completely within 6 months of implantation, leaving a permanent, not so biodegradable monofilament suture material (2-0 polyvinyl). This monofilament suture apparently remains permanently in the annulus of the mitral valve or tricuspid valve where it is used. The greatest question about this annuloplasty ring is the long-term durability of the device. In a study involving mitral valve repair in juvenile pigs published in the Journal of Heart Valve Disease, the authors reported that macroscopic measurements of valve orifice area showed the annulus had grown. They suggested that their annuloplasty ring allows for physiologic growth of the native annulus. However, it is unclear how the annuloplasty ring, which contains a nonabsorbable monofilament, can allow for physiologic growth of the annulus. If dilatation does occurs, this finding raises concern for the long-term support of any valve repair with this annuloplasty device, especially if not used as a complete ring. Long-term follow-up of these patients will be needed to determine if annular enlargement occurs despite the nonbiologic suture and to determine the long-term effects of the partially biodegradable ring compared with pericardium or cloth-covered annuloplasty rings, which have also shown excellent long-term results. Midterm Results of Valve Repair With a Biodegradable Annuloplasty Ring for Acute EndocarditisThe Annals of Thoracic SurgeryVol. 89Issue 4PreviewConventional annuloplasty rings consist of woven, nondegradable prosthetic material. Their use should theoretically be limited in acute infective endocarditis. Novel biodegradable annuloplasty rings, which are implanted into the annulus, carry theoretical advantages, but have never been evaluated for feasibility and mid-term outcome in such patients. Full-Text PDF