Department of surgery, King Abdulaziz University Hospital, King
Abdulaziz University Jeddah, Saudi Arabia
Corresponding Author
Khaled Ebrahim Al-Ebrahim, King Abdulaziz University Hospital, Jeddah,
Saudi Arabia.
Tel.966 559625170
Email:
dr.k.ebrahim@gmail.com
To the Editor
I congratulate Shojaeifard and colleagues for their successful
management of mechanical tricuspid valve thrombosis1.
Cardiac surgery nowadays is rapidly changing and at a crucial turning
point. Given the swift advances in interventional cardiology, cardiac
surgery operative decisions and strategy is different from the past when
we started cardiac surgery. The selection challenges between mechanical
and bio prothesis choice is now clearer and more obvious. Valve repair
is always the gold standard in any valve procedure as replacement of
either valve type will carry its own morbidity and mortality and
eventually, we are replacing one disease with another. From our
experience in the third world countries, the old concept that mechanical
valves are cost effective and better on the long run because of its
durability and avoidance of reoperation proved to be wrong. In contrary
to bio prostheses, mechanical valves entail close and strict follow up
of anticoagulation with all its thromboembolic and hemorrhagic
complications of this “rat poison” . Tricuspid valve
replacement especially when using mechanical valves is considered by
most surgeons as a catastrophic procedure2. Recently,
the advent of trans catheter procedures on aortic, mitral, and tricuspid
vale, repair and implantation really opened the door widely for the
interventional cardiologist to play a major role in all valve procedures
and affecting the volume and future of cardiac surgery practice and
resident training3. Transcatheter valve-in-valve
implantation within dysfunctional surgical bioprosthesis has become an
alternative to high risk redo open-heart surgery4.
This will change dramatically the trade- offs between mechanical and
bioprosthetic valve selection and may affect the future of mechanical
valves.
References
Shojaeifard M, Omidi N, Erami S,et al. Mechanical tricuspid valve
thrombosis: a mid term follow‐up study.JCardSurg.
2022;1‐10.doi:10.1111/jocs.16209
Sung K, Park PW, Park KH, Jun TG, Lee YT, Yang JH, Kim WS, Hwang J. Is
tricuspid valve replacement a catastrophic operation? Eur J
Cardiothorac Surg. 2009 Nov;36(5):825-9. doi:
10.1016/j.ejcts.2009.04.063. Epub 2009 Jul 8. PMID: 19589692.
3-Al‐Ebrahim EK, Madani TA, Al‐Ebrahim KE. Future of cardiac surgery,
introducing the interventional surgeon. Journal of Cardiac Surgery. 2022
Jan;37(1):88-92.
4- Deshpande SP, Sankova S, Dorsey N, Dawood MY, Tanaka K. Transcatheter
tricuspid valve-in valve replacement-hope for the forgotten valve!
Korean J Anesthesiol. 2020 Jun;73(3):264-266. doi: 10.4097/kja.20104.
Epub 2020 Mar 12. PMID: 32160737; PMCID: PMC7280897.