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says that the annular dilatation process is predominantly seen in the posterior annulus and it also involves the anterior part of the annulus, although to a lesser extent than the posterior annulus. There is no structure that prevents the annulus from dilatation in the sutureless transapical replacement of the valved stent in the mitral position. Therefore, left ventricular pressure in the systolic phase of cardiac cycle and even dynamic movement of the left heart may result in the separation of the annulus from the valved stent, especially in the posterior part of the annulus in the long-term follow-up. In conclusion, it is an admirable study. We readers thank the authors for sharing their experience and knowledge of a new surgical approach to minimally invasive mitral valve replacement. The explanation of previously described points may necessitate further investigation to overcome possible fixation problems.

Is a radially self-expanding valved stent with neochordal support enough for better fixation in the mitral position?