Minoru Tabata1, Kentaro Shibayama2, Hiroyuki Watanabe2, Yasunori Sato3, Toshihiro Fukui4, Shuichiro Takanashi4. 1. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. Electronic address: mtabata@post.harvard.edu. 2. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan. 3. Clinical Research Center, Graduate School of Medicine, Chiba University, Chiba, Japan. 4. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Abstract
OBJECTIVE: A supra-annular aortic valve prosthesis is often used for aortic valve replacement in patients with a small aortic annulus. However, which suture technique provides the best valve performance has not been studied. We aimed to compare valve performance between 2 different suture techniques. METHODS: We reviewed 152 patients undergoing aortic valve replacement with a 19- or 21-mm Carpentier-Edwards Perimount Magna aortic bioprosthesis (Edwards Lifesciences, Irvine, Calif) between June 2008 and December 2010. Simple interrupted sutures were used in 102 patients (group A, 19-mm prosthesis in 47 patients and 21-mm prosthesis in 55 patients), and noneverting mattress sutures were used in 50 patients (group B, 19-mm prosthesis in 20 patients and 21-mm prosthesis in 30 patients). Transthoracic echocardiograms were performed at baseline and before discharge in all patients and 1 year after surgery in 141 patients. We compared the effective orifice area and incidence of prosthesis-patient mismatch (effective orifice area index <0.85 cm(2)/m(2)) between 2 groups. RESULTS: The mean postoperative effective orifice areas were 1.41 ± 0.32 cm(2)/m(2) in group A and 1.30 ± 0.28 cm(2)/m(2) in group B (P = .025). The incidence of prosthesis-patient mismatch was 29% in group A and 56% in group B (P = .002). A multivariate analysis has shown that simple interrupted suturing is a negative predictor of prosthesis-patient mismatch (odds ratio, 0.33; 95% confidence interval, 0.13-0.83; P = .018). At 1 year, the incidence of prosthesis-patient mismatch was 27% in group A and 47% in group B (P = .023). CONCLUSIONS: 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.
OBJECTIVE: A supra-annular aortic valve prosthesis is often used for aortic valve replacement in patients with a small aortic annulus. However, which suture technique provides the best valve performance has not been studied. We aimed to compare valve performance between 2 different suture techniques. METHODS: We reviewed 152 patients undergoing aortic valve replacement with a 19- or 21-mm Carpentier-Edwards Perimount Magna aortic bioprosthesis (Edwards Lifesciences, Irvine, Calif) between June 2008 and December 2010. Simple interrupted sutures were used in 102 patients (group A, 19-mm prosthesis in 47 patients and 21-mm prosthesis in 55 patients), and noneverting mattress sutures were used in 50 patients (group B, 19-mm prosthesis in 20 patients and 21-mm prosthesis in 30 patients). Transthoracic echocardiograms were performed at baseline and before discharge in all patients and 1 year after surgery in 141 patients. We compared the effective orifice area and incidence of prosthesis-patient mismatch (effective orifice area index <0.85 cm(2)/m(2)) between 2 groups. RESULTS: The mean postoperative effective orifice areas were 1.41 ± 0.32 cm(2)/m(2) in group A and 1.30 ± 0.28 cm(2)/m(2) in group B (P = .025). The incidence of prosthesis-patient mismatch was 29% in group A and 56% in group B (P = .002). A multivariate analysis has shown that simple interrupted suturing is a negative predictor of prosthesis-patient mismatch (odds ratio, 0.33; 95% confidence interval, 0.13-0.83; P = .018). At 1 year, the incidence of prosthesis-patient mismatch was 27% in group A and 47% in group B (P = .023). CONCLUSIONS: 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.
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