Ibrahim Sultan1,2, Keith A Dufendach3, Arman Kilic3,4, Valentino Bianco3, Forozan Navid3,4, Thomas G Gleason3,4. 1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Pittsburgh, PA, 15232, USA. sultani@upmc.edu. 2. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, USA. sultani@upmc.edu. 3. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Pittsburgh, PA, 15232, USA. 4. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
Abstract
BACKGROUND: Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker. METHODS: 374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017. Patients with preoperative heart block, patients undergoing concomitant MAZE procedure and those undergoing multivalve procedures were excluded. Interrupted technique was performed with multiple non-pledgeted sutures. Running technique was performed with three 2-0 polypropylene sutures. Propensity-score matching (caliper distance = 0.10) was used to match based on patient age, gender, BMI, diabetes mellitus, renal failure, heart failure, arrythmias, use of anti-arrhythmics, and STS PROM. RESULTS: Propensity score matching yielded 103 pairs of running technique and interrupted technique patients for analysis. Within the propensity score-matched cohort, there were no differences in sustained complete heart block and need for pacemaker, 4 (3.8%) for running technique vs 3 (2.9%) for interrupted technique (p = 0.307). At 4 weeks, there was no difference in mean prosthetic aortic valve gradients calculated on transthoracic echocardiogram (6.39 ± 2.47 mmHg vs 6.46 ± 2.86, p = 0.850). There was no difference in paravalvular leak (0 (0%) vs 2 (1.9%), p = 0.070). CONCLUSIONS: Surgical implantation of a prosthetic aortic valve may be performed with a running suture technique without any significant increase in risk of heart block, need for permanent pacemaker or paravalvular leak. Long-term data will be critical to evaluate any development of paravalvular leaks in the future.
BACKGROUND: Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker. METHODS: 374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017. Patients with preoperative heart block, patients undergoing concomitant MAZE procedure and those undergoing multivalve procedures were excluded. Interrupted technique was performed with multiple non-pledgeted sutures. Running technique was performed with three 2-0 polypropylene sutures. Propensity-score matching (caliper distance = 0.10) was used to match based on patient age, gender, BMI, diabetes mellitus, renal failure, heart failure, arrythmias, use of anti-arrhythmics, and STS PROM. RESULTS: Propensity score matching yielded 103 pairs of running technique and interrupted technique patients for analysis. Within the propensity score-matched cohort, there were no differences in sustained complete heart block and need for pacemaker, 4 (3.8%) for running technique vs 3 (2.9%) for interrupted technique (p = 0.307). At 4 weeks, there was no difference in mean prosthetic aortic valve gradients calculated on transthoracic echocardiogram (6.39 ± 2.47 mmHg vs 6.46 ± 2.86, p = 0.850). There was no difference in paravalvular leak (0 (0%) vs 2 (1.9%), p = 0.070). CONCLUSIONS: Surgical implantation of a prosthetic aortic valve may be performed with a running suture technique without any significant increase in risk of heart block, need for permanent pacemaker or paravalvular leak. Long-term data will be critical to evaluate any development of paravalvular leaks in the future.
Authors: Alexander D Simms; Andrew J Hogarth; Elizabeth A Hudson; Victoria L Worsnop; Daniel J Blackman; David J O'Regan; Muzahir H Tayebjee Journal: Interact Cardiovasc Thorac Surg Date: 2013-04-25
Authors: Thomas T Poels; Patrick Houthuizen; Leen A F M Van Garsse; Mohammed A Soliman Hamad; Jos G Maessen; Frits W Prinzen; Albert H M Van Straten Journal: Eur J Cardiothorac Surg Date: 2014-12-03 Impact factor: 4.191
Authors: Bandar Al-Ghamdi; Yaseen Mallawi; Azam Shafquat; Alexandra Ledesma; Nadiah AlRuwaili; Mohamed Shoukri; Shahid Khan; Aly Al Sanei Journal: Cardiol Res Date: 2016-09-05