Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis

Abstract

Simple interrupted sutures provide larger effective orifice areas and reduce the incidence of prosthesis-patient mismatch after aortic valve replacement with a small supra-annular bioprosthesis. This suture technique is preferred in those patients to maximize valve performance.

Effect of aortic pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy

“…We previously demonstrated in a similar study that the use or nonuse of subannular pledgets did not influence valve hemodynamic performance. 17 Recent work by Tabata and colleagues 21 has supported that an interrupted nonpledget technique may be associated with a lower incidence of patient-prosthesis mismatch due to a relatively larger increase in effective orifice area. Therefore, the importance of this factor should be assessed in further work.…”

Does the type of suture technique affect the fluid-dynamic performance of bioprostheses implanted in small aortic roots? Results from an in vitro study

“…An explain of the discrepancy with our results might be found in fact that the patients in the study were not randomized and it might be possible that the initial tissue gathered underneath the valve may remodel over time and that the initial obstruction may decrease. In this regard, the data from Tabata et al showed a trend in this direction (4).…”

“…In this regard, two recent studies (4,5) involving small bioprostheses, i.e. with labeled sizes of 19 mm and 21 mm, came to different conclusions.…”

“…In addition, it has been hypothesized that the type of suture technique used to implant the prosthesis might influence hemodynamics (3,4) modifying the left ventricular outflow tract (LVOT) morphology nearby the sewing cuff. In this regard, two recent studies (4,5) involving small bioprostheses, i.e.…”

Skinning a cat

“…Our profession recognizes the presence of, and indeed the need for, multiple approaches to the care of a patient. Faced with an open aortic valve replacement, the surgeon must balance a triad of issues: (1) to maximize the effective orifice area (EOA) of the biologic prosthetic aortic valve (in part by not reducing the size of the annulus by the surgical technique of implantation), (2) to minimize the risk of a paravalvular leak, and (3) to optimize the ease of implantation.…”