Cikirikcioglu, Mustafa

Kalangos, Afksendiyos

Myers, Patrick O.

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Biodegradable materials for tricuspid valve repair in infectiveendocarditisPatrick O. Myers*, Mustafa Cikirikcioglu and Afksendiyos KalangosDepartment of Cardiovascular Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland* Corresponding author. Department of Cardiovascular Surgery, Faculty of Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva 14,Switzerland. Tel: +41-22-3727638; fax: +41-22-3727634; e-mail: patrick.myers@hcuge.ch (P. Myers)Received 16 August 2012; accepted 27 September 2012Keywords: Endocarditis • Tricuspid • Valve repair • Biodegradable materialsWe read with interest the report by Akinosoglou et al. [1] on thesurgical management of tricuspid valve infective endocarditis.We congratulate the authors for their excellent and extensivereview of the literature and for providing useful managementalgorithms. We would like to discuss biodegradable materials inthis patient group.The authors divide the surgical techniques into non-prostheticand prosthetic. However, there exists an intermediate option,which is not mentioned: the emerging role of biodegradablematerials in valve repair.Annuloplasty plays an important role in valve reconstruction,particularly if a signiﬁcantly infected leaﬂet segment must beresected to relieve tension on the repaired leaﬂets. We haveused a biodegradable annuloplasty ring, which is inserted suben-docardially, dissolves and is replaced by autologous ﬁbroustissue [2]. This might represent an advantage for this speciﬁcpatient population, due to the lack of blood contact and absorb-able ring material. We have previously reported our experienceusing this ring in patients with acute infective endocarditis [3, 4].Furthermore, the authors discuss patch reconstruction of deb-rided leaﬂets, but do not review the available materials and theirrelative beneﬁts in endocarditis. We are particularly interested inextracellular matrix scaffolds (such as CorMatrix©) for the repairof large leaﬂet defects, as these patches are intended to bereplaced by autologous tissue [5].These evolving biodegradable devices, from annuloplasty ringsto patch materials, offer the potential for valve repair with de-gradable materials replaced with autologous tissue, which couldfurther improve the results of valve repair for infective endocar-ditis. Long-term results are lacking and further data are necessaryto validate this theoretically interesting approach to infectiveendocarditis.REFERENCES[1] Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA.Right-sided infective endocarditis: surgical management. Eur JCardiothorac Surg 2012;42:470–9.[2] Kalangos A, Sierra J, Vala D, Cikirikcioglu M, Walpoth B, Orrit X et al.Annuloplasty for valve repair with a new biodegradable ring: an experi-mental study. J Heart Valve Dis 2006;15:783–90.[3] Pektok E, Sierra J, Cikirikcioglu M, Muller H, Myers PO, Kalangos A.Midterm results of valve repair with a biodegradable annuloplasty ring foracute endocarditis. Ann Thorac Surg 2010;89:1180–5.[4] Myers PO, Kalangos A, Pektok E, Cikirikcioglu M. Biodegradable ringannuloplasty for valve repair in children with endocarditis. J Card Surg2012;27:393; author reply 4.[5] Quarti A, Nardone S, Colaneri M, Santoro G, Pozzi M. Preliminary experi-ence in the use of an extracellular matrix to repair congenital heart dis-eases. Interact CardioVasc Thorac Surg 2011;13:569–72.LETTERSTOTHEEDITOREuropean Journal of Cardio-Thoracic Surgery 43 (2013) 873 LETTER TO THE EDITORdoi:10.1093/ejcts/ezs566 Advance Access publication 2 November 2012

Biodegradable materials for tricuspid valve repair in infective endocarditis

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