Simple Interrupted Suturing for Aortic Valve Replacement in Patients with Severe Aortic Stenosis

Abstract

Background: Attaining an adequate effective orifice area (EOA) is definitive goal in aortic valve replacement (AVR). The simple interrupted suture (SIS) technique could be a solution to achieve this goal, but limited data are available in the literature. This study aimed to compare hemodynamic differences between the SIS and non-everting mattress suture (NMS) techniques. Methods: From our database, 215 patients who underwent AVR for severe aortic stenosis were extracted to form the overall cohort. From March 2015 to November 2016, the SIS technique was used in 79 patients, while the NMS technique was used in 136 patients. Hemodynamic outcomes were evaluated, as detected by transthoracic echocardiography and computed tomography. Results: There were no significant differences in baseline characteristics between the 2 groups. On immediate postoperative echocardiography, the SIS group showed a significantly wider EOA (1.6±0.4 vs. 1.4±0.5 cm2, p=0.007) and a lower mean pressure gradient (PG) (13.3±5.4 vs. 17.0±6.0 mm Hg, p<0.001) than the NMS group. On follow-up echocardiography, the SIS group continued to have a wider EOA (1.6±0.4 vs. 1.4±0.3 cm2, p<0.001) and a lower mean PG (11.0±5.1 vs. 14.1±5.5 mm Hg, p<0.001). There was no significant difference in paravalvular leakage. Conclusion: The SIS technique for AVR was associated with a wider EOA and a lower mean PG. The SIS technique could be a reasonable option for AVR.

Keywords

• aortic valve surgery
• heart valve prosthesis
• surgery techniques
• effective orifice area
• patient prosthetic mismatch