Key result
Continuous suture links to ~5 mmHg lower peak gradients in <23mm aortic valves versus interrupted pledgets.
Why the study?
There is ambiguity in the literature regarding the continuous suture technique for aortic valve replacement.
Does the continuous suture technique improve in-hospital hemodynamics and clinical outcomes compared to the interrupted pledgeted technique in patients undergoing aortic valve replacement?
Cohort (n=1,356)
No
Does the continuous suture technique improve in-hospital hemodynamics and clinical outcomes compared to the interrupted pledgeted technique in patients undergoing aortic valve replacement?
Absolute Event Rate: 15.7% vs 20.5%
p-value: p=<0.001
The continuous suture technique for aortic valve replacement is safe and provides better postoperative hemodynamics, particularly in smaller annuli, compared to the interrupted pledgeted technique.
May support continuous suture in small-annulus AVR; hypothesis-generating pending randomized confirmation.
Background There is ambiguity in the literature regarding the continuous suture technique (CST) for aortic valve replacement (AVR). At our center, there has been a gradual shift towards CST over the interrupted pledgeted technique (IPT). This study aims at comparing outcomes for both techniques. Methods We performed a retrospective analysis of a single-center study of patients undergoing AVR between January 2011 and July 2020. Patients were divided into two groups: Continuous suture technique and interrupted pledget-reinforced sutures. The pre-operative and In-hospital clinical characteristics and echocardiographic hemodynamics (i.e. transvalvular gradients and paravalvular leakage) were compared between CST and IPT. Results We compared 791 patients with CST to 568 patients with IPT (median age: 73 and 74 years, respectively, p = 0.02). In CST there were 35% concomitant procedure vs 31% in IPT (p = 0.16). Early mortality was 3.2% in CST versus 4.8% in IPT (p = 0.15), and a second cross-clamp due to a paravalvular-leak in 0.5% vs. 1.2%, respectively (p = 0.22). The CST was not associated with new-onset conduction-blocks mandating pacemaker implants(OR 1.07, 95% CI 0.54–2.14; P = 0.85). The postoperative gradients on echocardiography were lower in CST compared to IPT, especially in smaller annuli (peak gradients: 15.7mmHg vs 20.5mmHg, in valve size < 23mm, p < 0.001) Conclusions The continuous suture technique was associated with lower postoperative gradients and shorter cross-clamp time compared to interrupted pledgeted technique. Differences in paravalvular leaks were non-significant, although slightly less in the continuous suture technique. There were no further differences in valve-related complications. Hence, continues suture technique is safe, with better hemodynamics compared to the interrupted pledgeted technique. This may be of clinical importance, especially in smaller size annular size.
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Arabkhani et al. (2023) conducted a cohort in Aortic valve disease requiring replacement (n=1,356). Continuous suture technique (CST) vs. Interrupted pledgeted technique (IPT) was evaluated on Postoperative peak transvalvular gradient in valve size < 23mm (mmHg) (p=<0.001). The continuous suture technique for stented bioprosthetic aortic valve replacement significantly reduced postoperative peak transvalvular gradients in valve sizes <23mm compared to the interrupted pledgeted technique.
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