Continuous Suture Technique for Aortic Valve Replacement Shortens Cross-Clamp and Bypass Times

The interrupted noneverting mattress suture technique is typically used in conventional surgical aortic valve replacement. The continuous suture technique, although faster, has been associated with a higher incidence of paravalvular leak. Using a slightly modified technique to minimize this risk, we investigated whether continuous suturing would shorten aortic cross-clamp time in aortic valve replacement in comparison with interrupted suturing. We reviewed the cases and compared the perioperative data of 60 consecutive patients in Japan and Australia (35 men and 25 women; median age, 70 yr) who had undergone aortic valve replacement with or without septal myectomy. The continuous suture technique had been used in 41 patients (Group CS) and the standard interrupted suture technique in 19 (Group IS). The groups were similar in age, sex, pathologic valvular conditions, and operative urgency. In Group CS, aortic cross-clamp time (47 vs 63 min; P=0.0001) and cardiopulmonary bypass time (76 vs 89 min; P=0.04) were significantly shorter. Neither group had early paravalvular leak. Using our continuous suture technique safely shortened aortic cross-clamp time during surgical aortic valve replacement.

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Aortic Valve Replacement with Continuous Suture

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230000800227 ◽

2000 ◽

Vol 8 (2) ◽

pp. 189-191

Author(s):

Ravi Agarwal ◽

Nainar Madhu Sankar ◽

Sethurathnam Rajan ◽

Rajarathinam Karnan Kalyan Singh ◽

Kotturathu Mammen Cherian

Keyword(s):

Developing Countries ◽

Postoperative Complications ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Suture Technique ◽

Paravalvular Leak ◽

Continuous Suture

A continuous suture technique for aortic valve replacement is described. The technique was used in 462 patients who underwent aortic valve replacement. Hospital mortality was 6.9%. Mild paravalvular leak was seen in 3% and 0.6% needed reoperation for significant paravalvular leak. This continuous suture technique is quick and effective, associated with few postoperative complications, and recommended for patients in developing countries.

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Anatomical circumstances and aortic cross-clamp time in minimally invasive aortic valve replacement

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa251 ◽

2020 ◽

Author(s):

Jure Jug ◽

Zdravko Štor ◽

Borut Geršak

Keyword(s):

Aortic Valve ◽

Linear Regression ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Linear Regression Model ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cross Clamp Time ◽

The Right

Abstract OBJECTIVES Prolonged operative times, potentially leading to increased morbidity, are a possible drawback of minimally invasive aortic valve replacement. The aim of this study was to assess the impact of anatomical circumstances in the chest on aortic cross-clamp time. METHODS This retrospective study included 68 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve via right-anterior thoracotomy or with ministernotomy. Anatomical variables were measured during preoperative computer tomography scans. RESULTS Aortic cross-clamp time was shorter in those having ministernotomy than in the right-anterior thoracotomy group (41.1 vs 52.3 min; P < 0.001). Cardiopulmonary bypass (CPB) time was not significantly different between groups (P = 0.09). A multivariable linear-regression model (P = 0.018) showed the aortic dextroposition variable to be a significant predictor of the aortic cross-clamp method and CPB times (P = 0.005 and P = 0.003) independent of other anatomical variables in the right thoracotomy group (10 mm deviation from optimal position prolonged the times for 240 and 600 s). For the whole cohort, a correlation between aortic valve dimensions and operative times was found (P = 0.046, P = 0.009). A linear-regression model (P = 0,046) predicted 90 s longer aortic cross-clamp time and 231 s longer CPB time for every 1 mm smaller aortic valve diameter. CONCLUSIONS The anatomical variables are associated with the operative times in minimally invasive aortic valve replacement with sutureless valves. Considering this association, preplanning the procedure is recommended.

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Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Scientific Reports ◽

10.1038/s41598-021-91548-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Charbel Abi Khalil ◽

Barbara Ignatiuk ◽

Guliz Erdem ◽

Hiam Chemaitelly ◽

Fabio Barilli ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Randomized Clinical Trials ◽

Severe Aortic Stenosis ◽

Paravalvular Leak ◽

Effective Orifice Area ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

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Continuous Suture Technique for Aortic Valve Replacement

Texas Heart Institute Journal ◽

10.14503/thij-18-6656 ◽

2018 ◽

Vol 45 (2) ◽

pp. 121-121 ◽

Cited By ~ 1

Author(s):

Mi Kyung Lee ◽

Jong Bum Choi ◽

Nan Yeol Kim

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Suture Technique ◽

Continuous Suture

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Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review

Journal of the American Heart Association ◽

10.1161/jaha.120.017347 ◽

2020 ◽

Vol 9 (16) ◽

Cited By ~ 1

Author(s):

Sophia L. Alexis ◽

Aaqib H. Malik ◽

Isaac George ◽

Rebecca T. Hahn ◽

Omar K. Khalique ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Prosthetic Valve Endocarditis ◽

Paravalvular Leak ◽

Surgical Aortic Valve Replacement ◽

Entry Site ◽

Transcatheter Aortic Valve ◽

Significant Difference

Abstract Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre‐2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle‐Ottawa Scale. Thirty‐three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%–1.2% per patient‐year versus 0.6%–3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo‐leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline‐directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.

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On “Continuous Suture Technique and Impairment of Atrioventricular Conduction After Aortic Valve Replacement”

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2000.tb01303.x ◽

2010 ◽

Vol 15 (6) ◽

pp. 423-423

Author(s):

Robert B. Karp

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Suture Technique ◽

Atrioventricular Conduction ◽

Continuous Suture

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Rescue Balloon Aortic Valvuloplasty After Sutureless Aortic Valve Replacement for Severe Paravalvular Leak

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519864938 ◽

2019 ◽

Vol 14 (5) ◽

pp. 476-479 ◽

Cited By ~ 1

Author(s):

Eiki Nagaoka ◽

Keita Sato ◽

Ali Hage ◽

Rodrigo Bagur ◽

Christopher Harle ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

New Technology ◽

Balloon Valvuloplasty ◽

Paravalvular Leak ◽

Aortic Cross Clamp ◽

Balloon Aortic Valvuloplasty ◽

Sutureless Valve ◽

The Right

Sutureless aortic valve replacement (AVR) is a wide-spreading new technology that provides short clamping time and excellent hemodynamic outcomes. However, among its possible complications is the risk of paravalvular leak. We present the case of a 63-year-old woman who underwent minimally invasive right mini-thoracotomy AVR) with Perceval S sutureless valve (LivaNova, London, UK). Intraoperative transesophageal echocardiography revealed severe paravalvular leak with stent distortion. Rescue balloon valvuloplasty was performed through the right femoral artery, and resulted in the resolution of the paravalvular leak. This case illustrates the utility and feasibility of balloon valvuloplasty in trouble-shooting sutureless aortic valve stent distortion, thus avoiding a repeat aortic cross-clamp and valve replacement.

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Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR: a retrospective study from the USA

BMJ Open ◽

10.1136/bmjopen-2018-022437 ◽

2018 ◽

Vol 8 (12) ◽

pp. e022437 ◽

Cited By ~ 1

Author(s):

Ratnasari Padang ◽

Mahmoud Ali ◽

Kevin L Greason ◽

Christopher G Scott ◽

Manasawee Indrabhinduwat ◽

...

Keyword(s):

Overall Survival ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Risk Score ◽

Paravalvular Leak ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Sts Score

ObjectiveThe presence of aortic paravalvular leak (PVL) is associated with lower survival, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not been performed. This study sought to determine the differential influence of PVL on survival following TAVR versus SAVR and in patients with varying levels of risk as defined by the Society of Thoracic Surgeons (STS) risk score.MethodsPatients with and without postprocedural PVL were identified from 2290 patients undergoing TAVR or SAVR at Mayo Clinic between 2008 and 2014. The primary endpoint was overall survival.ResultsThere were 588 patients with PVL (374 TAVR, 214 SAVR): age 78±11 years, 63% male and mean follow-up of 3±2 years. PVL was trivial/mild in 442 (75%) patients. In propensity-matched analyses (n=86 per group), the overall survival at 1 and 4 years was 93% and 56% vs 89% and 61% in patients with PVL after TAVR versus SAVR, respectively (p=0.43). The presence or degree of PVL severity had no influence on survival of patients with high STS score (≥8%), while the presence of greater than mild PVL predicted worse survival in those with STS score <8%. During the first year after PVL diagnosis, while either improvement or stable PVL grade was seen in the majority of patients, worsening of PVL grade was more common in the TAVR group (19%) versus the SAVR group (4%) (p<0.0001).ConclusionsAt mid-term follow-up, the presence of PVL was associated with equally unfavourable outcomes following SAVR or TAVR. In patients with high STS risk score, the presence of PVL was not independently associated with increased mortality.

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