Transaortic Double Valve Replacement

To the Editor:

I read with interest the case report ¹ on transaortic mitral and aortic valve replacement with total preservation of the mitral valve chordae. Without any intent of detracting from the surgeons' well-deserved credit for having performed this procedure successfully in 4 cases, I wish to comment on a few issues.

First, their decision to replace the mitral valve has left me perplexed. Should mere thickening of the mitral valve, especially with only mild incompetence, have necessitated replacement? Second, the logic behind releasing adhesions to expose both the atria and the venae cavae also eludes comprehension, as these steps appear to be dispensable. Third, the decision to preserve all the chordae was noble; however, the availability of a St. Jude Medical mechanical valve for use in the mitral position should have enabled the implantation of that prosthesis with total preservation of the native mitral valve ^2–4 which might have been technically simpler. Last, in the presence of mitral stenosis with atrial fibrillation, the authors' approach precludes the detection of small, echocardiographically undetected left atrial thrombi and also the obliteration of the left atrial appendage.