[HSF] Trip to Croatia

[bbiocina at kbd.hr]

As  discussion is again approaching Mitrofast concept , I have no choice
than to ( unvillingly)  again declare that:
1. Rather than a device , Mitrofast is a concept of  arteficial
coaptation surface  of the posterior leaflet ( hemi-valve replacement).
Arteficial support of  other two main parts of the mitral valve( ring
and suspensory apparatus) had already been successfuly exploited(ring 
much earlier , chordae later on)
2. Feasibility study conducted here in Zagreb  proved that the concept
works ( ECHOs available) , at least  for  short/mid  term ( longest
follow up 2 1/2 y). However , actual  design of device(s) based on such
concept is amenable to changes/evolution.
3.Skepticism  about that concept is mainly based  on presumption that 
natural coaptation surface is better than arteficial (scaffolded treated
xenopericardium). If it  was true , natural suspensory apparatus  ( with
accordingly based  techniques of  chordal shortening , transposition
etc.) should be better  of arteficial chordal (Goretex) support , and
that is not the case. Moreover ,  all  of us witnessed  famous
surgeons/experts ( names ommited) who claimed  superiority  of natural
suspensory apparatus for decades. As there is  no proof that  arteficial
 coaptation surface is better than  natural one  either , I think time
and reported experience  will be the best judge.
4. Even if I agreed that conventional reparability of the posterior
leaflet makes Mitrofast unnecessary , "repairability" contains a broad
spectrum of difficulty- from simple quadrangular/imbrication to very
complex  time consuming repairs). As Mitrofast implantation technique 
is completely unrelated to the extent of PML pathlogy , the question of 
cost ( e.g. x-clamp time) of  PML repairability may also be asked.
5. In case of completely unrepairable PML , Mitrofast concept is an
viable option. Surgeons from Augsburg , Germany , were able to repair
two  PML endocarditis ( one healed , one  active)  with excision  of PML
and Mitrofast placement. It shows there is , at least , a niche  for
such  concept.( I hope they will not wait for publication as long as I
do).
6. As , even in Croatia , we see wery few reumatic patients , the
judgement  of  applicability  should be left to Prasanna and his fellows
, as they see such pathology on daily basis.

Bojan

On 4/7/2007, "Hgrmd at aol.com" <Hgrmd at aol.com> wrote:

>Bob,
>  While he was still in Croatia, Prasanna and I were talking off line  about
>Mitrofast.  He was discussing possible practical uses of Mitrofast,  and I'd
>like to share them with HSF since I think they could turn out to be  apt.  I'm
>in complete agreement that Mitrofast doesn't make much sense if  the posterior
>leaflet is repairable.  Carpentier's techniques and Goretex  should be able
>to reliably repair such leaflets. However, with severe rheumatic  damage or
>perhaps a calcified posterior annulus, perhaps Mitrofast might be  usable and
>better (?) than a replacement.
>
>Hal
>
>
>
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