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We would like to thank our colleagues for their comments regarding our article [1Scherner M. Madershahian N. Strauch J.T. Wippermann J. Wahlers T. Transapical valve implantation and resuscitation: risk of valve destruction.Ann Thorac Surg. 2011; 92: 1909-1910Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar] and for presenting the technique of abdominal-only cardiopulmonary resuscitation (CPR) as another feasible alternative in patients in whom sternal compression is contraindicated or at least supposed to be harmful [2Rottenberg E.M. Dimitrova G.T. Crestanello J.A. Awad H. The need for alternative methods of cardiopulmonary resuscitation when sternal compression is contraindicated.Ann Thorac Surg. 2012; 93 (letter): 2117-2152Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar]. Therefore, we would like to add some comments on the discussion for alternative methods of CPR. In line with Rottenberg and colleagues, we are of the opinion that clinicians who are involved in postoperative care of cardiac surgery patients should be aware of the mentioned scenarios. From a more general point of view, two questions should be taken into consideration. First, cardiac surgeons have to deal with increasing number of different expandable valve prosthesis to simplify valve implantation. All these valves are fixed on different types of frames to fix the devices in the deployed location [3Folliguet T. Dibie A. Laborde F. Future of cardiac surgery: minimally invasive techniques in sutureless valve resection.Future Cardiol. 2009; 5: 443-452Crossref PubMed Scopus (8) Google Scholar]. In regard to our report, further evaluation has to be done to estimate the risk of a potential valve dislocation or destruction during CPR in these valves. Second, Rottenberg and colleagues [4Dunning J. Fabbri A. Kolh P.H. et al.Guideline for resuscitation in cardiac arrest after cardiac surgery.Eur J Cardiothorac Surg. 2009; 36: 3-28Crossref PubMed Scopus (102) Google Scholar] mentioned the published specific guidelines concerning CPR after cardiac surgery. As we can only report a single case in which we successfully performed our described technique, our concern is to provide one possible way to perform CPR after transcatheter aortic valve implantation. Adam and colleagues [5Adam Z. Adam S. Everngam R.L. et al.Resuscitation after cardiac surgery: results of an international survey.Eur J Cardiothorac Surg. 2009; 36: 29-34Crossref PubMed Scopus (9) Google Scholar] published the results of their survey to ascertain an international viewpoint on resuscitation after cardiac surgery, illustrating that only 32% of the respondents follow CPR guidelines and only 7% regularly practice these clinical scenarios [5Adam Z. Adam S. Everngam R.L. et al.Resuscitation after cardiac surgery: results of an international survey.Eur J Cardiothorac Surg. 2009; 36: 29-34Crossref PubMed Scopus (9) Google Scholar]. Having these facts in mind, we would like to underscore the necessity of educated and trained multidisciplinary teams in specialized centers to guarantee the best possible treatment in these particular emergency scenarios. Reports and debates such as these may contribute to the improvement of patient care and might give reason to further investigate the discussed topic. The Need for Alternative Methods of Cardiopulmonary Resuscitation When Sternal Compression Is ContraindicatedThe Annals of Thoracic SurgeryVol. 93Issue 6PreviewWe read with great interest the case report recently published by Scherner and colleagues [1] regarding their experience with destruction of a percutaneous aortic valve implant during postoperative cardiopulmonary resuscitation (CPR) necessitated by a refractory ventricular arrhythmia unresponsive to defibrillation and drug therapy. After a total of 75 minutes of CPR, they determined that life-support action was no longer effective and the patient subsequently died. Autopsy findings revealed compression and deformation of the aortic valve prosthesis as the only abnormality caused by CPR, which most likely led to failed resuscitation. Full-Text PDF