Key result
Simple suture technique shows no significant benefit over pledgeted technique for severe prosthesis-patient mismatch.
Why the study?
The study aimed to compare postoperative outcomes and patient-prosthetic mismatch following aortic valve replacement with an 18-21 mm mechanical bi-leaflet valve using pledgeted versus simple suture techniques in patients with small aortic annulus.
Does interrupted non everting pledgeted suture technique compared to simple suture technique influence patient prosthetic mismatch in isolated aortic stenosis patients with small aortic annulus undergoing AVR?
Observational (n=68)
No
Does interrupted non everting pledgeted suture technique compared to simple suture technique influence patient prosthetic mismatch in isolated aortic stenosis patients with small aortic annulus undergoing AVR?
The use of simple suture technique had a slight, non-statistically significant benefit over pledgeted technique in reducing the incidence of severe patient prosthetic mismatch in patients with small aortic annulus undergoing AVR.
Background: This study aims at comparing post-op outcome and incidence of patient prosthetic mismatch (PPM) post aortic valve replacement (AVR) using pledgeted versus simple suture technique in isolated aortic stenosis patients with small aortic annulus undergoing AVR with 18-21 mm mechanical bi-leaflet valve in Indian population. Methods: A retrospective study, conducted in KEM Hospital, Mumbai in patients who underwent AVR between January 2015 to December 2018. Pre-operative data and 1-year post-op hemodynamic data of patients undergoing AVR using interrupted non everting pledgeted and interrupted simple suture technique were compared. Results: 68 patients were selected for study after applying exclusion criteria (pledgeted 44, simple 24). Both groups were comparable in terms of age (p=0.46), sex (p=0.41), and valve pathologies. Incidence of severe PPM was higher in pledgeted group in patients with valve size 18-19 mm (p=0.20) but similar in valve size 20-21 mm group (p=0.30). Patients with severe and moderate PPM had poor post-operative LV function. Conclusions: PPM is a common and alterable entity. Severe PPM is responsible for adverse hemodynamic function and congestive heart failure among patients with small sized aortic valve implantation (18-21 mm). Use of simple suture technique had a slight benefit over pledgeted technique in reducing incidence of severe PPM (not statistically significant) and better recuperation during short term follow up.
No takes yet. Share an insight, caveat, or question.
Kothari et al. (2023) conducted an observational in Isolated severe aortic stenosis with small aortic annulus (n=68). Interrupted simple suture technique vs. Interrupted non-everting pledgeted mattress suture technique was evaluated on Severe prosthesis-patient mismatch (PPM) at 1 year (p=0.46). In patients with a small aortic annulus undergoing aortic valve replacement, the simple suture technique resulted in a non-significant reduction in severe prosthesis-patient mismatch compared to the pledgeted technique (8.3% vs 11.4%, p=0.46).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: