Letter:
To the Editor,
I read the article ”Minimally invasive aortic valve repair using
geometric ring annuloplasty” by Joshua N. Baker MD et al.1 with
enthusiasm. It was helpful to understand this manuscript, and the
author’s efforts should be commended. In conclusion, geometric ring
annuloplasty appeared to be safe and effective for use in minimally
invasive aortic valve repair, including the full spectrum of the valve
and proximal aortic pathologies. However, I believe it is necessary to
state additional points that would supplement the brilliance of this
article and add to the preceding information.
To begin, significant concerns arise due to the study’s retrospective
nature due to the significant risk of bias in the patient’s history and
documentation, which resulted in unjustifiable outcomes. Furthermore,
only a small number of people were included in the study, reducing the
sample size and power of the study, which may have influenced their
results. Furthermore, the authors did not provide better operative
images such as views over leaflet repair techniques, detailed view of
annuloplasty ring placement and suture fixation procedures to better
understand this surgical technique, which might have been a crucial
strength if the authors had also put forward this information. However,
a 2015 study by Domenico Mazzitelli et al.2 imparted a splendid
graphical and realistic perspective of this procedure. Cardiovascular
procedures, as previously stated, are associated with considerable
hemodynamic preoperative and postoperative problems, providing more
information for future evaluation of this approach. As a result, the
authors should have described the procedure’s varied problems and
results. For instance, 2014 research included annular diameter, ring
diameter, leaflet prolapse, and other treatments such as ascending
aortic aneurysm replacement, remodeling root aneurysm repair, and
pericardial leaflet extension, and Systolic gradient and valve area.
Finally, valve-sparing root surgeries’ long-term results and
reproducibility have improved with time. This is partly due to the
development of surgical techniques to treat and repair the AV cusps and
address the annulus. According to current medical evidence, AV repair is
safe, reduces valve-related mortality compared to prosthetic valve
replacement, improves the quality of life, and has a life expectancy
comparable to the general population. Researchers are exploring less
invasive techniques to do annuloplasty and other heart valve surgeries
by employing longer, narrow tubes. The majority of aortic valves can now
be reconstructed with adequate outcome measures attributable to the
application of a pathoanatomic approach to aortic insufficiency.
According to new research, the restoration of inadequate aortic leaflets
might be associated with lower surgical mortality, fewer valve-related
problems, and improved survival.