[HSF] Access to AV groove area post bypass Bioprosthesis choice

[Giulio Rizzoli]

At 16.01 20/01/2008, you wrote:
> > There is also no need to "excise" leaflets or 
> more precisely disrupe the> annulopapillary 
> contnuity .  In fact I may make an inflammatory 
> comment that it is> unethical not to preserve 
> annulopappillary continuity in modern day mitral> valve surgery
> >> Prasanna
>Yes Prasanna, I would say that is a rather 
>inflammatory comment! As you know this chordal 
>sparing business was largely an invention of Dr 
>David in the 1980s. There is however a paper (in 
>press) from David's group questioning the 
>validity of this technique. David et al looked 
>at all MVRs done over 15 years in their 
>institution and found no difference in patients 
>who had chordal sparing (these procedures 
>largely done by David who is an ardent believer 
>like you) vs no chordal preservation (these 
>largely done by his colleagues). Of course one 
>would have expected chordal sparing to do better 
>for two reasons - because the chords were spared 
>and because they were operated by one of the 
>most talented surgeons of the era...yet the data showed no difference.
>
>Ani

For many years we have performed successful 
surgery without cordal sparing, in the 80's we 
started with posterior chordal preservation. 
(Recently we added anterior chordal preservation).
  We have no evidence of  any clinical 
improvement, there has been a trend toward 
reduced operative mortality which is linked to 
meny improvements ( may be also to chordal 
preservation). There has been a lower incidence 
of posterior ventricular rupture ( probably 
related to posterior chordal preservation). There 
have been occasional cases of cardiomyopathy 
requiring transplantation despite posterior 
chordal preservation ( few events for a meaningfull statistic).
                                                                             Giulio 
Rizzoli

Giulio Rizzoli MD FETCS
Cardiochirurgia Padova
tel. 049 821-2408
fax 049 821-2409
e-mail giulio.rizzoli at unipd.it

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