Reply to Tavlasoglu

ography and cardiac computed tomography. Four of six surviving pigs were sacrificed at 4 weeks after implantation and one at 8 weeks thereafter. One pig died due to an unrecognized valved stent malpositioning that occurred 4 days after implantation. All the animals exhibited normal haemodynamics immediately after mitral valved stent implantation and maintained stability for 6 h of monitoring. They claimed that all animals had been implanted with a bovine pericardial valved stent without any technical failures. The haemodynamic results were good enough. However, the question to be clarified is if the fixation technique of the valved stent will be enough for a better fixation in the long-term follow-up. The mitral valve apparatus does not have a whole anatomical annulus. It is actually a discontinuous band of a connective tissue that exists only in some parts of the attachment of the posterior leaflet [2]. This means, unlike the aortic position, using a sutureless technique in the mitral position may result in dislocation of the valved stent even if it has basal neochordal support. Since, according to Adam and Carpentier’s discussion [3], Carpentier 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.