The Florida Sleeve Repair: Letter 2

Abstract

I read with great interest the article by Hess and colleagues [1Hess P.J. Harman P.K. Klodell C.T. et al.Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms.Ann Thorac Surg. 2009; 87: 1161-1169Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar] and I would like to congratulate the authors in successfully developing a new procedure for the correction of aortic insufficiency due to root aneurysms. I would like to draw your attention to one of our articles published elsewhere in 2001 [2Kawazoe K. Izumoto H. Sato Y. Eishi K. Ishibashi K. Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology.Surg Today. 2001; 31: 27-31Crossref PubMed Scopus (15) Google Scholar], which was presented at the 10th Annual Meeting of the European Association for Cardio-Thoracic Surgery held at Prague in 1996. The procedure we presented was called the annuloaortic repair, which was a similar technique to the Florida sleeve. However, there are a couple of points of technical difference as follows. The sleeve graft was a treated equine pericardium in our procedure [2Kawazoe K. Izumoto H. Sato Y. Eishi K. Ishibashi K. Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology.Surg Today. 2001; 31: 27-31Crossref PubMed Scopus (15) Google Scholar], not the Valsalva graft [1Hess P.J. Harman P.K. Klodell C.T. et al.Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms.Ann Thorac Surg. 2009; 87: 1161-1169Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar]. A row of proximal mattress stitches were placed just above the aortic annulus in ours [2Kawazoe K. Izumoto H. Sato Y. Eishi K. Ishibashi K. Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology.Surg Today. 2001; 31: 27-31Crossref PubMed Scopus (15) Google Scholar], not in the subvalvular area, such as in the Florida sleeve [1Hess P.J. Harman P.K. Klodell C.T. et al.Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms.Ann Thorac Surg. 2009; 87: 1161-1169Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar]. For the differences, they are not the same procedure, although they look like the same. I must add a historical fact that Ergin and Griepp [3Ergin M.A. Griepp R.B. When, why, and how should the native aortic valve be preserved in patients with annuloaortic ectasia or Marfan syndrome?.Semin Thorac Cardiovasc Surg. 1993; 5: 91-92PubMed Google Scholar] reported a prototype procedure in 1993. For some reason, I missed reading the first report on the Florida sleeve [4Hess P.J. Klodell C.T. Beaver T.M. Martin T.D. The Florida sleeve: a new technique for aortic root remodeling with preservation of the aortic valve and sinuses.Ann Thorac Surg. 2005; 80: 748-750Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar]; however, I would like to again congratulate the authors for bringing this new procedure to our attention. ReplyThe Annals of Thoracic SurgeryVol. 89Issue 1PreviewWe appreciate the letters from Drs Gamba and colleagues [1] and Izumoto [2]. We were not aware of Izumoto's [3] article of an inclusion annuloplasty technique in 2001, but on review, we are very impressed with his group's development of this externally reinforced root repair. There are several similarities to the Florida Sleeve, but in contrast to Izumoto's [3] method, we strongly recommend placement of proximal graft anchoring sutures below the aortic annulus. This reduces the likelihood of ongoing dilatation of the sinuses beneath the graft. Full-Text PDF