Use of a nonpledgeted suture technique is safe and efficient for aortic valve replacement

Abstract

Objective The use of pledgeted sutures to secure the prosthetic valve to the annulus during aortic valve replacement is thought to decrease the incidence of paravalvular leak. We hypothesized that use of nonpledgeted sutures in aortic valve replacement would provide equivalent outcomes to those of a pledgeted suture technique. Methods Between January 1995 and April 2009, a total of 802 patients (511 nonpledgeted, 291 pledgeted) underwent isolated aortic valve replacement, including 671 patients who underwent primary, isolated aortic valve replacement (412 nonpledgeted, 259 pledgeted). Preoperative risk, intraoperative findings, and postoperative complications, including operative mortality, were evaluated. Results Operative mortalities in isolated AVR operations were similar at 2.5% and 3.1% (P > .66) for nonpledgeted and pledgeted groups, respectively. Paravalvular leak rates after aortic valve replacement were equivalent in nonpledgeted and pledgeted groups (0.8% vs 1.4%, respectively, P = .47). Reoperation for paravalvular leak was rare in both groups. Importantly, the nonpledgeted technique incurred significantly shorter aortic crossclamp time (58.1 ± 0.3 minutes vs 61.6 ± 0.4 minutes, P < .001) and cardiopulmonary bypass time (87.5 ± 0.8 minutes vs 90.3 ± 0.8 minutes, P = .02) than did the pledgeted technique. Conclusions A nonpledgeted suture technique offers an equivalent alternative to the traditional use of pledgets during aortic valve replacement, with no increase in paravalvular leak rate. This nonpledgeted suture technique provides a time efficient and safe approach to aortic valve replacement operations.

Outcomes of Nonpledgeted Horizontal Mattress Suture Technique for Mitral Valve Replacement

“…Pledgeted horizontal mattress sutures with large braided suture materials have long been used as a standard suture technique for MVR [ 1 ]. One study has demonstrated that the use of a nonpledgeted horizontal mattress suture technique during aortic valve replacement did not increase the rate of PVL in comparison with the use of a pledgeted suture technique [ 7 ]. In the present study, a major PVL occurred in 1.1% of patients in the P group and 2.9% of patients in the N group, which was a non-significant difference.…”

“…In this study, we review 10 years of our experience with nonpledgeted sutures during MVR to assess whether this technique is equivalent to a pledgeted technique with respect to operative mortality, the rate of major PVL, and the rate of prosthetic valve endocarditis. A recent study has shown that the nonpledgeted horizontal mattress suture technique during aortic valve replacement is safe and time efficient [ 7 ], but no study concerning the use of a nonpledgeted horizontal mattress suture technique during MVR has previously been published.…”

Surgical Management of Minimally Invasive Aortic Valve Operations

“…We prefer to place nonpledgeted horizontal mattress sutures from the ventricle to the aorta. 26 The sutures are passed through the prosthetic valve and the valve is seated in the annulus. Care must be ensured that the coronary ostia are not obstructed by the valve posts or sewing ring.…”

Has the technique of aortic valve replacement an effect on the postoperative fate of the patient?

“…LaPar a spol. 8 srovnávají dvě skupiny pacientů po prosté náhradě aortální chlopně implantované jednotlivými stehy s podložkami a bez podložek. Stejně jako v našem souboru jediným statisticky významným rozdílem je délka studené ischemie a délka mimotělního oběhu.…”