Letters to the Editor / European Journal of Cardio-thoracic Surgery 38 (2010) 647—650
by Ugurlucan et al., but the pump flow is lowered to obtain a thin film of blood emerging from the anastomotic incision in the ascending aorta. Obviously, there are many ways of ‘skinning a cat’, and I do not claim that mine is better, but I just wanted to draw the attention of the surgical fraternity to a simple and very efficacious technical adjunct in some cases of coronary surgery.
References  Ugurlucan M, Selimoglu O, Ogus TN, Isik O. Aorta non-clamp technique in case of sclerotic ascending aorta during coronary artery bypass grafting. Eur J Cardiothorac Surg 2010;38:648.  Antunes MJ. Open anastomosis: an alternative for proximal vein graft anastomoses in significantly diseased aortas. Eur J Cardiothorac Surg 2010; 37:492—3.
* Corresponding author. Tel.: +351 239400418; fax: +351 239829674. E-mail address: [email protected]
group are greater in number than patients older than 60 years old (385 vs 374). How is it possible? Third, there were 20 early deaths and, of the 361 survivors, 24 patients were lost to follow-up (6.6%), and 228 were late deaths; 66 deaths were due to undetermined causes and 35 deaths were due to valve-related causes. Of these, only two were structural valve deterioration (SVD). Of the 66 undetermined deaths, we do not know the rate of structural failure or deterioration. Only 19 cases were reoperated on due to SVD, but how many patients had SVD without re-operation? Were they studied? If the follow-up was performed by telephone interview, as Minami reported , this may have limited the detection of valve-related pathology. Structural valve deterioration is a process occurring over a prolonged period of time and the real incidence may have been less than the rate that would be detected by periodic echocardiographic studies . How many patients had SVD without clinical significance? The authors concluded in their exposure ‘The Mitroflow. . ., has very acceptable durability, at 10 years, for patients >60 years.’ We think that with these data, we cannot conclude that affirmation.
Letter to the Editor Mitroflow aortic pericardial bioprosthesis ´lvarez, Juan Sierra Quiroga *, Jose´ Rubio A Jose M. Martı´nez-Cereijo, Cristian Delgado Cardiac Surgery Service, Hospital Clı´nico Universitario, Santiago de Compostela, Spain Received 2 February 2010; accepted 8 March 2010
 Jamieson WRE, Koerfer R, Yankah CA, Zittermann A, Hayden RI, Ling H, Hetzer R, Dolman WB. Mitroflow aortic pericardial bioprosthesis — clinical performance. Eur J Cardiothorac Surg 2009;36:818—24.  Minami K, Zittermann A, Schulte-Eistrup S, Koertke H, Ko ¨rfer R. Mitroflow synergy prostheses for aortic valve replacement: 19 years experience with 1,516 patients. Ann Thorac Surg 2005;80:1699—705.  Yankah CA, Schubel J, Buz S, Siniawski H, Hetzer R. Seventeen-year clinical results of 1,037 Mitroflow pericardial heart valve prostheses in the aortic position. J Heart Valve Dis 2005;14:172—9.  Alvarez JR, Sierra J, Vega M, Adrio B, Martinez-Comendador J, Gude F, Martinez-Cereijo J, Garcia J. Early calcification of the aortic Mitroflow pericardial bioprosthesis in the elderly. Interact CardioVasc Thorac Surg 2009;9:842—6.
Keywords: Heart valves; Aortic valve replacement; Pericardial bioprosthesis
We read with great interest the article ‘Mitroflow aortic pericardial bioprosthesis — clinical performance’ published by Jamieson and colleagues  and we have a few queries regarding the contents and conclusions of the article. First, this is a retrospective study, performed with patients from three different hospitals (Bad Oeynhausen, Berlin and Vancouver) operated on between 1992 and 2003 using the Mitroflow pericardial bioprosthesis, model 12. The study involved a total of 381 patients. Minami (from Bad Oeynhausen) reported in 2005 the implantation of 1024 valves of Mitroflow model 12 . Yankah (from Berlin) published in 2005 the clinical results of 1037 Mitroflow bioprosthesis implanted between 1986 and 2003  (a great number of these valves probably were Mitroflow model 12). So, the first question is if there are now 381 patients included in the article, why were the other patients excluded? What kind of bias was made in the population data? Second, in the given data and Table 1, the authors made two groups: less than 70 years old and older. Nevertheless, in Fig. 2, the graphic captions are ‘60 years’ and ‘65 years’. Even more, the patients at risk in the older than 65-year-old
* Corresponding author. Address: Hospital Clı´nico, c/Choupana s/n, Santiago, Spain. Tel.: +34 981 950212; fax: +34 981 950227. E-mail address: [email protected]
(J. Sierra Quiroga). doi:10.1016/j.ejcts.2010.03.022
Reply to the Letter to the Editor Reply to Quiroga et al. William Robert Eric Jamieson *,1 Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada Received 6 March 2010; accepted 8 March 2010; Available online 13 May 2010 Keywords: Bioprosthesis; Structural valve deterioration; Calcification
This letter is a response to the letter to the editor by Quiroga et al. , to the article by Jamieson et al.