Reply

Abstract

We read with interest the comments of Dr Massetti and coworkers concerning the infection rate during our minimally invasive approach to the aortic valve operations. We published in the group treated with ministernotomy approach (60 patients) two cases of early endocarditis, one case of an endocarditis after 12 months, and two cases of superficial wound infections [1Mächler H.E. Bergmann P. Anelli-Monti M. et al.Minimally invasive versus conventional aortic valve operations a prospective study in 120 patients.Ann Thorac Surg. 1999; 67: 1001-1005Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar]. We agree with the authors that the cumulative rate of infection in this series is higher than in the standard sternotomy group.The risk for contamination seems to be increased because the skin has more contact with the surgeon’s hands, the aortic tissue, and the entire wound, because the incision is much smaller. As a consequence, we are using textiles to cover the skin and the sternum, the surgeon is changing his gloves before knotting the sutures to fix the prostheses, and we are performing more direct venous cannulations. Until that time, we performed 58 new cases with the minimally invasive procedure (a total of 118 patients) without any new case of endocarditis or wound infection (cumulative rate: 1.8% of early endocarditis, 0.8% of late endocarditis, 1.8% of wound infections).In conclusion, we think that the statement of Dr Massetti and coworkers is extremely important, and we appreciate the opportunity to be able to clarify our present management for the minimally invasive approach to aortic valve procedures. We read with interest the comments of Dr Massetti and coworkers concerning the infection rate during our minimally invasive approach to the aortic valve operations. We published in the group treated with ministernotomy approach (60 patients) two cases of early endocarditis, one case of an endocarditis after 12 months, and two cases of superficial wound infections [1Mächler H.E. Bergmann P. Anelli-Monti M. et al.Minimally invasive versus conventional aortic valve operations a prospective study in 120 patients.Ann Thorac Surg. 1999; 67: 1001-1005Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar]. We agree with the authors that the cumulative rate of infection in this series is higher than in the standard sternotomy group. The risk for contamination seems to be increased because the skin has more contact with the surgeon’s hands, the aortic tissue, and the entire wound, because the incision is much smaller. As a consequence, we are using textiles to cover the skin and the sternum, the surgeon is changing his gloves before knotting the sutures to fix the prostheses, and we are performing more direct venous cannulations. Until that time, we performed 58 new cases with the minimally invasive procedure (a total of 118 patients) without any new case of endocarditis or wound infection (cumulative rate: 1.8% of early endocarditis, 0.8% of late endocarditis, 1.8% of wound infections). In conclusion, we think that the statement of Dr Massetti and coworkers is extremely important, and we appreciate the opportunity to be able to clarify our present management for the minimally invasive approach to aortic valve procedures.