Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT)☆

Englberger, Lars; Schaff, Hartzell V.; Jamieson, W.R. Eric; Kennard, Elizabeth D.; Im, Kyung Ah; Holubkov, Richard; Carrel, Thierry

doi:10.1016/j.ejcts.2005.09.014

Cited by 56 publications

(39 citation statements)

References 14 publications

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“…In the present study, early mitral PVL was recorded in only 1.9% of the patients, contrary to findings of previous studies that early PVL was detected in up to 32% of MVR patients [1,3]. This might be owing to the fact that we avoided the continuous suture technique, which has proved to be associated with a high incidence of PVL after MVR [2,7]. In addition to suture technique, previous studies suggested that the presence of heavy annular calcification, small body surface area, and size and type of prosthetic valve were associated with mitral PVL [1,2,[7][8][9][10].…”

Section: Commentcontrasting

confidence: 99%

“…This might be owing to the fact that we avoided the continuous suture technique, which has proved to be associated with a high incidence of PVL after MVR [2,7]. In addition to suture technique, previous studies suggested that the presence of heavy annular calcification, small body surface area, and size and type of prosthetic valve were associated with mitral PVL [1,2,[7][8][9][10]. In the present study, however, we could not demonstrate that such factors are associated with incidence of mitral PVL.…”

Section: Commentcontrasting

confidence: 78%

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Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

Hwang

Choi

Hyung-Kwan

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentcontrasting

confidence: 99%

Section: Commentcontrasting

confidence: 78%

Paravalvular Leak After Mitral Valve Replacement: 20-Year Follow-Up

Hwang

Choi

Hyung-Kwan

et al. 2015

The Annals of Thoracic Surgery

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“…Pledgeted sutures to the secure the valve prosthesis to the valve annulus during mitral, aortic, and double mechanical valve replacements have been shown to have a protective effect against postoperative paravalvular leak in comparisons with several different suture techniques. 4 To our knowledge, however, the effect of a uniform, nonpledgeted suture technique during AVR has not been previously well established.…”

mentioning

confidence: 99%

Use of a nonpledgeted suture technique is safe and efficient for aortic valve replacement

LaPar

Ailawadi

Bhamidipati

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Objective The use of pledgeted sutures to secure the prosthetic valve to the annulus during aortic valve replacement is thought to decrease the incidence of paravalvular leak. We hypothesized that use of nonpledgeted sutures in aortic valve replacement would provide equivalent outcomes to those of a pledgeted suture technique. Methods Between January 1995 and April 2009, a total of 802 patients (511 nonpledgeted, 291 pledgeted) underwent isolated aortic valve replacement, including 671 patients who underwent primary, isolated aortic valve replacement (412 nonpledgeted, 259 pledgeted). Preoperative risk, intraoperative findings, and postoperative complications, including operative mortality, were evaluated. Results Operative mortalities in isolated AVR operations were similar at 2.5% and 3.1% (P > .66) for nonpledgeted and pledgeted groups, respectively. Paravalvular leak rates after aortic valve replacement were equivalent in nonpledgeted and pledgeted groups (0.8% vs 1.4%, respectively, P = .47). Reoperation for paravalvular leak was rare in both groups. Importantly, the nonpledgeted technique incurred significantly shorter aortic crossclamp time (58.1 ± 0.3 minutes vs 61.6 ± 0.4 minutes, P < .001) and cardiopulmonary bypass time (87.5 ± 0.8 minutes vs 90.3 ± 0.8 minutes, P = .02) than did the pledgeted technique. Conclusions A nonpledgeted suture technique offers an equivalent alternative to the traditional use of pledgets during aortic valve replacement, with no increase in paravalvular leak rate. This nonpledgeted suture technique provides a time efficient and safe approach to aortic valve replacement operations.

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“…Ten years after heart valve replacement, up to 50% of the patients require reoperation or die of complications related to the prosthetic heart valves. There is usually no difference between mechanical and biological prostheses, but the frequency and nature of the complications related to the prostheses vary according to type, model, and valve position, as well as to each patient's characteristics 4,[11][12][13][14][15] . By quantifying the comparative odds ratios between patients who presented varying degrees of prosthetic valve leak, the present study contributes to a better knowledge of its clinical outcome and provides information to guide therapies and establish prognoses.…”

Section: Discussionmentioning

confidence: 99%