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Impact of suture techniques for aortic valve repalcement on prosthesis-patient mismatch

Authors
 Hyo-Hyun Kim  ;  Sak Lee  ;  Hyun-Chel Joo  ;  Jung-Hwan Kim  ;  Young-Nam Youn  ;  Kyung-Jong Yoo  ;  Seung-Hyun Lee 
Citation
 ANNALS OF THORACIC SURGERY, Vol.109(3) : 661-667, 2020-03 
Journal Title
 ANNALS OF THORACIC SURGERY 
ISSN
 0003-4975 
Issue Date
2020-03
MeSH
Aged ; Aortic Valve / anatomy & histology ; Aortic Valve / surgery* ; Aortic Valve Insufficiency / etiology ; Aortic Valve Insufficiency / surgery ; Female ; Follow-Up Studies ; Heart Failure / etiology ; Heart Failure / surgery ; Heart Valve Prosthesis Implantation / methods* ; Heart Valve Prosthesis* / adverse effects ; Hemodynamics ; Humans ; Male ; Middle Aged ; Patient Readmission ; Postoperative Complications ; Proportional Hazards Models ; Suture Techniques*
Abstract
Background: Many variables may affect the hemodynamic performance of the aortic valve prosthesis, and suture technique remains an important factor for determining maximum valve performance. The objective of this study was to determine the suture technique that produces better hemodynamic performance for aortic valve replacement (AVR). Methods: Patients who underwent AVR between January 2015 and September 2018 in our institution were analyzed. We compared the preoperative clinical information and 1-year postoperative hemodynamic data of interrupted pledget mattress sutures (pledgeted group), interrupted nonpledget mattress sutures (nonpledgeted group), and figure-of-8 nonpledget sutures (figure-of-eight group). We compared the incidence of prosthesis-patient mismatch (PPM) and cardiac adverse events among the groups and subanalyzed the PPM rate in a small aortic annulus (18 to 21 mm). Results: A total of 439 patients underwent AVR (pledgeted, n = 212; nonpledgeted, n = 122; figure-of-eight, n = 105). The groups were similar in age (P = .359), sex (P = .055), underlying disease, and valve pathology. There was no difference in inhospital mortality or cardiac adverse events in each suture group (P = .282). The nonpledgeted suture had significantly lower moderate (P < .01) and severe PPM rates (P = .01) in patients with a small aortic annulus (18 to 21 mm). Conclusions: The interrupted nonpledget mattress suture offers complete supraannular implantation, which reduces the incidence of PPM and results in better hemodynamic improvement after small-size AVR.
Full Text
https://www.sciencedirect.com/science/article/pii/S0003497519315619
DOI
10.1016/j.athoracsur.2019.09.012
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyohyun(김효현) ORCID logo https://orcid.org/0000-0002-1608-9674
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/178385
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