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Asian Cardiovasc Thorac Ann 1999;7:359
© 1999 Asia Publishing EXchange Pte Ltd

LETTER TO THE EDITOR

We Can Top That With a Photo

Reida El Oakley, FRCS, MD, Emad Al Bukhari, FRCS

Cardiac Department National University Hospital 5 Lower Kent Ridge Road Singapore 11907 Republic of Singapore
A letter to the editor of the Journal of Thoracic and Cardiovascular Surgery, entitled "Can You Top This?", has sparked a number of responses.1–4 The letter and responses were regarding the longest-recorded functioning bioprosthesis; some of the responses were over optimistic.

We present the case of a 45-year-old man who had an aortic valve replacement with a no. 23 Biocor porcine bioprosthesis (St Jude Medical, Inc., Minneapolis, MN, USA) on January 16, 1979. The prosthesis was replaced on September 8, 1998, after 19 years and 235 days. The bioprosthetic valve leaflets were thickened and calcified (Figure 1Go). One of the leaflets was severely damaged and had a central fibrous band adherent to the adjacent leaflets. Echocardiography immediately prior to the second operation showed severe aortic regurgitation and mild stenosis with globally impaired left ventricular function (ejection fraction, 40%). Figure 1Go shows that such a valve carries a considerable risk of systemic embolization if left in situ.



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  		Figure 1. The porcine bioprosthesis explanted after 19 years and 235 days.

 
Bioprosthetic valve longevity has been topped by others.2–4 However, we need to keep in mind that a longlasting diseased tissue valve poses a continuous threat of systemic embolization or endocarditis. Furthermore, regardless of how long the current bioprosthetic valves last, it is often not long enough.

References

  1. Oury JH. Can you top this [letter]? J Cardiovasc Thorac Surg 1997;114:147.[Free Full Text]

  2. Flege JB. "This" is topped again [letter]. J Cardiovasc Thorac Surg 1998;116:884.[Medline]

  3. Goldin MD. I, too, can top this [letter]. J Cardiovasc Thorac Surg 1998;115:736.[Free Full Text]

  4. Paone G, Myers D. We did top this [letter]. J Cardiovasc Thorac Surg 1998;115:736.





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