Suture Technique in Preventing Dehiscence of Prosthetic Mitral Valves

Stiles, Geoffrey; Kernen, Jules A.; Stiles, Quentin R.

doi:10.1001/archsurg.1986.01400100042008

Cited by 6 publications

(8 citation statements)

References 10 publications

(1 reference statement)

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“…The fact that there is little or no tissue in growth into the prosthetic ring regardless of the age of the prosthetic valve [6], supports the hypothesis that an intact and durable suture line is important.…”

Section: Introductionsupporting

confidence: 53%

“…We examined 30 hearts from female pigs between the 27th of August and 9th of December at the Biomedical Laboratory at the University of Southern Denmark. 30 hearts were available during the study period, and this sample size matches that of the previous studies [6] [8] [9]. The pigs weighed 25 -45 kg, and we had no influence on the size of the pigs we received.…”

Section: Methodsmentioning

confidence: 68%

“…Finally, Stiles et al did not find any significant difference in durability between suture techniques with pledgets and non-supported sutures, though they tend to conclude that sutures with pledgets are superior [6].…”

Section: ) No Difference Between the Semicontinuous Technique And Inmentioning

confidence: 94%

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The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model

Hougaard¹,

Schäfer²,

Riber³

2021

OJTS

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Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers' exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon's choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.

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Section: Introductionsupporting

confidence: 53%

Section: Methodsmentioning

confidence: 68%

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The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model

Hougaard¹,

Schäfer²,

Riber³

2021

OJTS

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“…If the tear is severe, suture dehiscence and paravalvular leakage can occur. The use of pledgets can avert loosened sutures and paravalvular leakage by dispersing the pressure and patching the suture tear [Stiles 1986]. The high spatial resolution of multidetector computed tomography can clearly reveal the details of paravalvular structures without hindrance from acoustic shadowing or the limited acoustic window and spatial resolution of echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement

Baydar

Coşkun²,

Balaban³

et al. 2013

HSF

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Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.

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“…Several investigators including ourselves have clearly demonstrated that mechanical prosthetic entrapment can easily be avoided by using Miki's technique and removing the excess chordal tissue on an individualized basis [51,71]. Subannular pledgeted mattress sutures are of much more benefit for prevention of ventricular rupture when the total valve is excised [72][73][74][75][76].…”

Section: Technical Considerations For Prevention Of Left Ventriculamentioning

confidence: 99%

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

Gudala¹,

Chauhan²,

Jena³

et al. 2019

JICOA

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The present perspective is a synthesis of 108 published investigations in the setting of different types of left ventricular rupture following mitral valve replacement (MVR). We identified 109 investigations and reviewed the clinical presentation, diagnostic modalities, surgical techniques and outcomes. Clinical presentation, roentgenography, cross-sectional transthoracic/transesophageal echocardiography and computerized tomography provided the diagnostic information and defined the causative mechanism. Magnetic resonance imaging had been used for further clarification of the native ventricular anatomy in high-risk subset of patients, undergoing non-traditional transapical off-pump mitral valve repair with neochordal implantation. In this article, we have attempted to address several concerning issues and controversies with reference to the possible causative mechanisms, preventive measures, the issue of chordal preservation during MVR, the degree of decalcification required in cases of heavily calcified mitral annulus, selection of appropriate sized prosthetic valves, the surgical importance of a small left ventricle, various techniques of repair, role of cardiopulmonary bypass and cardioplegic arrest during the repair of left ventricular rupture, the role of biodegradable epicardial tissue sealants, to repair or not to repair the atrio-ventricular groove hematoma during mitral valve surgery, and the role of intra-aortic balloon counterpulsation in the perioperative period. Additionally, we have highlighted a new type of left ventricular rupture described in the literature located between the base of the papillary muscle and the apex, which can be categorized as a complication of new technologies of mitral valve repair such as NeoChord device artificial chordal implantation. We have classified this category as type IV ventricular rupture. Overall, this review attempts to address the guidelines for different surgical approaches and techniques of repair of different types of left ventricular rupture for a successful outcome. We submit that an increased appreciation of the causative mechanisms of different types of left ventricular rupture and its prevention may well contribute to improved surgical management.

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Suture Technique in Preventing Dehiscence of Prosthetic Mitral Valves

Cited by 6 publications

References 10 publications

The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model

The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model

Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

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Suture Technique in Preventing Dehiscence of Prosthetic Mitral Valves

Cited by 6 publications

References 10 publications

The Optimal Suture Technique for Mitral Valve Replacement in an &lt;i&gt;Ex Vivo&lt;/i&gt; Animal Model

The Optimal Suture Technique for Mitral Valve Replacement in an &lt;i&gt;Ex Vivo&lt;/i&gt; Animal Model

Cardiac Tamponade due to Left Ventricular Pseudoaneurysm After Aortic Valve Replacement

A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

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The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model

The Optimal Suture Technique for Mitral Valve Replacement in an <i>Ex Vivo</i> Animal Model