Key result
Park's central stitch reduces aortic insufficiency by ~2 grades in LVAD patients.
Why the study?
The evolution of aortic valve insufficiency after Park's central stitch in patients with severe native AI undergoing LVAD implantation was not well established.
Does Park's central stitch improve aortic valve insufficiency in continuous flow LVAD patients with severe preoperative native AI?
Cohort (n=71)
Does Park's central stitch improve aortic valve insufficiency in continuous flow LVAD patients with severe preoperative native AI?
Absolute Event Rate: 0.75% vs 2.75%
p-value: p=<0.05
Park's central stitch provides a simple, short-ischemic-time surgical option to effectively correct severe native aortic insufficiency during LVAD implantation.
Central stitch may stabilize AI in select LVAD patients; leaves open need for prospective validation before wider adoption.
PURPOSE: To evaluate the evolution of aortic valve insufficiency (AI) after Park's central stitch in patients with severe, preoperative, native aortic valve insufficiency. METHODS: We retrospectively studied 71 continuous flow LVAD patients between January 2004 and December 2010. Four patients with AI≥3/4 were treated with a central stitch. An intensive review of the literature was performed to debate the use of the central stitch in this population. RESULTS: The AI at baseline (AI = 2.75 ± 0.5) and AI at last measurement (AI = 0.75 ± 0.65) is statistically different after central stitch (p<0.05) with mean follow up of 198.25 (± 146.70) days. Total cross clamp-time during the placement of the stitch was 15.5 minutes (± 13.062). CVA was not diagnosed in our cohort. CONCLUSIONS: Park's central stitch can be successfully performed on patients with severe native AI (≥3/4) with good long-term results. Short ischemic time and simple application of the stitch are the biggest advantages. Due to the progression of AI in longstanding LVAD, the central stitch may be beneficial for LVAD in destination therapy. Since this is a small group of patients and also an early experience, more cases will be necessary to confirm these positive results.
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Praetere et al. (2013) conducted a cohort in Severe native aortic valve insufficiency in LVAD patients (n=71). Park's central stitch over the Arantius' nodules vs. Baseline (pre-operative) was evaluated on Aortic valve insufficiency (AI) grade (p=<0.05). Park's central stitch significantly reduced aortic valve insufficiency from a baseline grade of 2.75 to 0.75 (p<0.05) in LVAD patients with severe native AI.
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