Reply to de Kerchove et al.: 'Rather addition than extension of Florida sleeve indications'.

Abstract

We read the invited commentary by de Kerchove et al. entitled ‘Is extension of Florida Sleeve indications taking us in the right direction?’ [1] in reference to our work [2] with great interest. We thank the authors for their valuable comments. In fact, there is no uniform technique to perform aortic valve (AV) reimplantation. David [3] himself published variations up to David V. There is a vast body of technical development. In our department, we also implemented steps to create a sinus bulge to avoid retraction of the right coronary base and to adapt for the geometry of bicuspid AVs [4]. We have started using AV reimplantation in 1992 and over years only sporadically used the Florida sleeve technique. Performing more complex operations and treating elderly patients, we had a concern of prolonged clamp times especially when concomitant surgery was indicated. Another indication was borderline dilatation of the aortic root. The question is what to do with a young adult with myxomatous mitral valve disease and an aortic root of 40 mm diameter? This kind of wrapping of the root, nearly without any risk of bleeding, could be an acceptable prophylactic tool. In AV repair, one faces frequently dilated roots by far not reaching the current indication for the root replacement. The sleeve around the aorta provides potentially a stable geometry and eases the judgement for AV cusp repair.