Key result
Figure-of-eight sutures in AVR are linked to ~62% lower odds of moderate PPM vs pledgets.
Why the study?
While the pledget suture technique is standard for surgical AVR, whether nonpledget suture techniques produce superior structural and hemodynamic parameters remains an open question.
Does the figure-of-eight suture technique reduce prosthesis-patient mismatch compared to the pledget suture technique in patients undergoing surgical aortic valve replacement?
Cohort (n=629)
No
Does the figure-of-eight suture technique reduce prosthesis-patient mismatch compared to the pledget suture technique in patients undergoing surgical aortic valve replacement?
The figure-of-eight suture technique in surgical aortic valve replacement significantly reduces the incidence of moderate prosthesis-patient mismatch compared to the standard pledget suture technique.
May inform suture selection in SAVR to reduce moderate PPM; hypothesis-generating and requires randomized confirmation.
BACKGROUND: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
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Rasheed et al. (2023) conducted a cohort in Severe aortic valve disease requiring surgical aortic valve replacement (n=629). Figure-of-eight suture technique vs. Pledget suture technique was evaluated on Moderate prosthesis-patient mismatch (PPM) (OR 2.65, 95% CI 1.35-4.70, p=0.007). The figure-of-eight suture technique in aortic valve replacement reduced the incidence of moderate prosthesis-patient mismatch to 15.3% compared to 29.3% with the pledget suture technique.
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