Continuous or interrupted pledgeted suture technique in stented bioprosthetic aortic valve replacement: a comparison of in-hospital outcomes.

Autor: Arabkhani B; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium. bardia.arabkhani@gmail.com.; Department of Cardio-Thoracic Surgery, Erasmus Medical Center (EMC), Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands. bardia.arabkhani@gmail.com., Gonthier S; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium., Lorenz V; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium., Deschamps S; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium., Jahanyar J; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium.; Division of Cardiothoracic Surgery, Department of Surgery, Queen's Heart Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA., Boute M; Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, B-1200, Belgium., Vancraeynest D; Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, B-1200, Belgium., Mastrobuoni S; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium., Khoury GE; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium., de Kerchove L; Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic surgery [J Cardiothorac Surg] 2024 Apr 04; Vol. 19 (1), pp. 174. Date of Electronic Publication: 2024 Apr 04.
DOI: 10.1186/s13019-024-02754-3
Abstrakt: Background: There is ambiguity in the literature regarding the continuous suture technique (CST) for aortic valve replacement (AVR). At our center, there has been a gradual shift towards CST over the interrupted pledgeted technique (IPT). This study aims at comparing outcomes for both techniques.
Methods: We performed a retrospective analysis of a single-center study of patients undergoing AVR between January 2011 and July 2020. Patients were divided into two groups: Continuous suture technique and interrupted pledget-reinforced sutures. The pre-operative and In-hospital clinical characteristics and echocardiographic hemodynamics (i.e. transvalvular gradients and paravalvular leakage) were compared between CST and IPT.
Results: We compared 791 patients with CST to 568 patients with IPT (median age: 73 and 74 years, respectively, p = 0.02). In CST there were 35% concomitant procedure vs. 31% in IPT (p = 0.16). Early mortality was 3.2% in CST versus 4.8% in IPT (p = 0.15), and a second cross-clamp due to a paravalvular-leak in 0.5% vs. 1.2%, respectively (p = 0.22). The CST was not associated with new-onset conduction-blocks mandating pacemaker implants(OR 1.07, 95% CI 0.54-2.14; P = 0.85). The postoperative gradients on echocardiography were lower in CST compared to IPT, especially in smaller annuli (peak gradients: 15.7mmHg vs. 20.5mmHg, in valve size < 23 mm, p < 0.001).
Conclusions: The continuous suture technique was associated with lower postoperative gradients and shorter cross-clamp time compared to interrupted pledgeted technique. Differences in paravalvular leaks were non-significant, although slightly less in the continuous suture technique. There were no further differences in valve-related complications. Hence, continues suture technique is safe, with better hemodynamics compared to the interrupted pledgeted technique. This may be of clinical importance, especially in smaller size annular size.
(© 2024. The Author(s).)
Databáze: MEDLINE
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