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Is it Time to Look for an Alternative?

I read with interest the editorial by Dr. Kabbani, 1 who clearly outlined three approaches to mitral valve replacement in developing countries. He compared availability, ease of implantation, and durability. His emphasis on the thromboembolic complications of valve replacement and the difficulties with anticoagulation in the developing world are well known and accepted. There are, however, two other alternatives to consider: complex mitral valve repair, and the Deac procedure. The concept of the irreparable rheumatic mitral valve needs to be reassessed and debated. It is accepted that the actuarial freedom from reoperation following mitral valve repair ranges from 60% to 70% at 10 years, with the highest failure rates during the first 2 to 3 years, especially in the under 20-year-old age group. 2,3 It may, however, be appropriate to accept a higher failure rate when one considers the higher morbidity and mortality of valve replacement requiring anticoagulation. Yet, economics and access may mitigate against the subsequent increased rate of reoperation in the repair group. The Deac procedure is an ingenious technique utilizing the patient’s own pericardium. 4