[HSF] Access to AV groove area post bypass Bioprosthesis choice(stentless valves)

[rwmfglycar at aol.com]

By doing away with rings and struts a hemodynamic improvement was achieved in small aortic roots. This without doubt resulted in less resistance across the aortic orifice than provided by the contemporaneously available stented valves and this in turn produced greater regression of LV hypertrophy. Since left ventricular hypertrophy is a risk factor for death this seemed like a good idea.
The downside of the several stentless valves on the market was that many surgeons found them difficult to insert. This last issue never went away and there were many surgeons who found them too difficult to use and more or less said there is some regression of hypertrophy with stented valves and that is good enough for me. In the meantime the design of stented valves improved so that the difference in hemodynamic performance became substantially less. Sales of the stentless valves decreased annually until it became economically impossible to maintain the plant needed to continue building them.
   It is unfair to characterise the development of stentless valves as a collusion between industry and surgeons. It is not a myth that left ventricular hypertrophy is not good for the patient. That is why from the late 60's to the early 2000's I routinely emlarged the aortic root to try to get valves inserted that gave  single digit mean pressure drops. This goal is worthwhile. I dislike the term "patient-prosthesis mismatch" semantically but this does not alter the proper pathophysiologic goal needed to address left ventricular outflow obstruction.
  There are many good ideas that fail for economic reasons.
Bob

     


-----Original Message-----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 21 Jan 2008 5:20 am
Subject: AW: [HSF] Access to AV groove area post bypass Bioprosthesis choice



Yes, but which is the reason?
ay be Bob knows...
oberto
-----Ursprüngliche Nachricht-----
on: openheart-l-bounces at lists.hsforum.com
mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Hgrmd at aol.com
esendet: Montag, 21. Januar 2008 03:18
n: OpenHeart-L at lists.hsforum.com
etreff: Re: [HSF] Access to AV groove area post bypass Bioprosthesis choice
Prasanna,
 On the basis of one study, I certainly don't plan to cut out the  
ubvalvular apparatus with impunity.  However, it's always good to keep an
pen mind.  
 well remember Tirone's lectures over 10 years ago about the  virtues of 
tentless aortic valves in LV mass regression.  It's my  understanding that
he 
anufacture of the Toronto valve was recently  discontinued.

al

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