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Abstract

We appreciate the comments of Bottio and colleagues on our recent report of intraoperative failure involving 4 bovine pericardial mitral prostheses.1 The correspondents point out that Carpentier-Edwards Perimount bioprostheses require physiologic pressure to overcome the inherent limited leaflet coaptation that results from no-pressure fixation. They further comment that had the valves in our report been subjected to more physiologic hemodynamics, they might have demonstrated normal function. To correct any misunderstanding, we would note that 2 of the valve failures were demonstrated after separating from cardiopulmonary bypass with acceptable hemodynamics. At physiologic pressures, there was still massive incompetence, as demonstrated by means of transesophageal echocardiography. The other 2 failed valves were tested before atrial closure. In each of these cases, the degree of insufficiency observed by the surgeons was extremely severe and far greater than that associated with incomplete closure of a pericardial valve at low pressures, a phenomenon with which we are quite familiar. Carpentier-Edwards Perimount valve and intraoperative structural failureThe Journal of Thoracic and Cardiovascular SurgeryVol. 128Issue 5PreviewWe read with great interest the article by Saunders and associates.1 The authors described a post–cardiopulmonary bypass (post-CPB) structural valve failure, leading to an intraoperative replacement of 4 Carpentier-Edwards Perimount valves. The negative experience has been lived in 2 different institutions. Two Perimount valves were replaced because of a severe central insufficiency at the weaning-off phase from CPB, another valve was replaced soon after its insertion because of being judged not continent as a result of the impossibility of leaflet coaptation before atrial closure, and the last as a result of incompetence at hydraulic testing.The pericardial tissue valves were replaced with either a new Carpentier-Edwards porcine valve or a Medtronic Mosaic porcine valve. Full-Text PDF