Figure of eight suture technique in aortic valve replacement decreases prosthesis-patient mismatch

While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figur...

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Bibliographic Details
Published in:	Journal of cardiothoracic surgery Vol. 18; no. 1; p. 117
Main Authors:	Rasheed, Nabeel F, Stonebraker, Corinne, Li, Zhaozhi, Siddiqi, Umar, Lee, Andy C H, Li, Willa, Lupo, Sydney, Cruz, Jennifer, Cohen, William G, Staub, Cathy, Rodgers, Daniel, Myren, Mark, Combs, Pamela, Jeevanandam, Valluvan, Hibino, Narutoshi
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 10-04-2023 BioMed Central BMC
Subjects:	Aorta Aortic valve Aortic Valve - surgery Aortic Valve Stenosis - surgery Body size Heart Valve Prosthesis Heart Valve Prosthesis Implantation - methods Heart valves Hemodynamics Humans Implants, Artificial Mortality Orifices Patients Prostheses Prosthesis Prosthesis Design Statistical analysis Suture Techniques Sutures Treatment Outcome
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Summary:	While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figure-of-eight suture technique in AVR, as determined by the incidence of prosthesis-patient mismatch (PPM). We reviewed records of patients (N = 629) who underwent a surgical AVR procedure between January 2011 and July 2018 at a single institution. Indexed effective orifice area values and PPM incidence were calculated from implanted valve size and patient body surface area. Incidence of none, moderate, and severe PPM was compared across AVR suture techniques. A total of 570 pledget and 59 figure-of-eight patients were compared for incidence of PPM. Patients who received AVR with the pledget suture technique had significantly lower echocardiographic measurements of baseline ejection fraction than patients who had received AVR with the figure-of-eight suture technique (p = 0.003). Patients who received the figure-of eight suture had a 14% decrease in moderate PPM compared to patients who received the pledget suture (p = 0.022). Patients who received the figure-of-eight suture also had a significantly higher rate of no PPM (p = 0.044). The use of the figure-of-eight suture technique in AVR can reduce the incidence of moderate PPM. While the pledget suture is the standard technique in AVR, the figure-of-eight suture technique may offer better structural and hemodynamic outcomes, especially for patients with a smaller aortic annulus.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	1749-8090 1749-8090
DOI:	10.1186/s13019-023-02260-y