Skip to main content

12.09.2018 | Original Article

A running suture line for aortic valve replacement does not increase the rate of postoperative complete heart block

verfasst von: Ibrahim Sultan, Keith A. Dufendach, Arman Kilic, Valentino Bianco, Forozan Navid, Thomas G. Gleason

Erschienen in: General Thoracic and Cardiovascular Surgery

Einloggen, um Zugang zu erhalten

Abstract

Background

Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker.

Methods

374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017. Patients with preoperative heart block, patients undergoing concomitant MAZE procedure and those undergoing multivalve procedures were excluded. Interrupted technique was performed with multiple non-pledgeted sutures. Running technique was performed with three 2–0 polypropylene sutures. Propensity-score matching (caliper distance = 0.10) was used to match based on patient age, gender, BMI, diabetes mellitus, renal failure, heart failure, arrythmias, use of anti-arrhythmics, and STS PROM.

Results

Propensity score matching yielded 103 pairs of running technique and interrupted technique patients for analysis. Within the propensity score-matched cohort, there were no differences in sustained complete heart block and need for pacemaker, 4 (3.8%) for running technique vs 3 (2.9%) for interrupted technique (p = 0.307). At 4 weeks, there was no difference in mean prosthetic aortic valve gradients calculated on transthoracic echocardiogram (6.39 ± 2.47 mmHg vs 6.46 ± 2.86, p = 0.850). There was no difference in paravalvular leak (0 (0%) vs 2 (1.9%), p = 0.070).

Conclusions

Surgical implantation of a prosthetic aortic valve may be performed with a running suture technique without any significant increase in risk of heart block, need for permanent pacemaker or paravalvular leak. Long-term data will be critical to evaluate any development of paravalvular leaks in the future.
Literatur
1.
Zurück zum Zitat Callaghan JC. Replacement of the aortic and mitral valves using the starr-edwards ball-valve prosthesis: a report of 50 cases. Can Med Assoc J. 1964;91:411–21.PubMedPubMedCentral Callaghan JC. Replacement of the aortic and mitral valves using the starr-edwards ball-valve prosthesis: a report of 50 cases. Can Med Assoc J. 1964;91:411–21.PubMedPubMedCentral
2.
Zurück zum Zitat Spencer FC, Trinkle JK, Eiseman B, Reeves JT, Surawicz B. Aortic valve replacement in elderly patients with cardiac failure. Jama. 1964;189:103–7.CrossRefPubMed Spencer FC, Trinkle JK, Eiseman B, Reeves JT, Surawicz B. Aortic valve replacement in elderly patients with cardiac failure. Jama. 1964;189:103–7.CrossRefPubMed
3.
Zurück zum Zitat Gott VL, Daggett RL, Whiffen JD, Koepke DE, Rowe GG, Young WP. A hinged-leaflet valve for total replacement of the human aortic valve. J Thorac Cardiovasc Surg. 1964;48:713–25.PubMed Gott VL, Daggett RL, Whiffen JD, Koepke DE, Rowe GG, Young WP. A hinged-leaflet valve for total replacement of the human aortic valve. J Thorac Cardiovasc Surg. 1964;48:713–25.PubMed
4.
Zurück zum Zitat Sultan I, Komlo CM, Bavaria JE. How I teach a valve sparing root replacement. Ann Thorac Surg. 2016;101(2):422–5.CrossRefPubMed Sultan I, Komlo CM, Bavaria JE. How I teach a valve sparing root replacement. Ann Thorac Surg. 2016;101(2):422–5.CrossRefPubMed
5.
Zurück zum Zitat Villa E, Clerici A, Messina A, Testa L, Bedogni F, Moneta A, et al. Risk factors for permanent pacemaker after implantation of surgical or percutaneous self-expanding aortic prostheses. J Heart Valve Dis. 2016;25(6):663–71.PubMed Villa E, Clerici A, Messina A, Testa L, Bedogni F, Moneta A, et al. Risk factors for permanent pacemaker after implantation of surgical or percutaneous self-expanding aortic prostheses. J Heart Valve Dis. 2016;25(6):663–71.PubMed
6.
Zurück zum Zitat Poels TT, Houthuizen P, Van garsse LA, Soliman Hamad MA, Maessen JG, Prinzen FW, et al. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement. Eur J Cardiothorac Surg. 2015;47(2):e47–53.CrossRefPubMed Poels TT, Houthuizen P, Van garsse LA, Soliman Hamad MA, Maessen JG, Prinzen FW, et al. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement. Eur J Cardiothorac Surg. 2015;47(2):e47–53.CrossRefPubMed
7.
Zurück zum Zitat Baraki H, Al ahmad A, Jeng-singh S, Saito S, Schmitto JD, Fleischer B, et al. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg. 2013;16(4):476–81.CrossRefPubMedPubMedCentral Baraki H, Al ahmad A, Jeng-singh S, Saito S, Schmitto JD, Fleischer B, et al. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg. 2013;16(4):476–81.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, et al. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2013;17(2):328–33.CrossRefPubMedPubMedCentral Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, et al. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg. 2013;17(2):328–33.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Totaro P, Calamai G, Montesi G, Barzaghi C, Vaccari M. Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement. J Card Surg. 2000;15(6):418–22.CrossRefPubMed Totaro P, Calamai G, Montesi G, Barzaghi C, Vaccari M. Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement. J Card Surg. 2000;15(6):418–22.CrossRefPubMed
10.
Zurück zum Zitat Choi JB, Kim JH, Park HK, Kim KH, Kim MH, Kuh JH, et al. Aortic valve replacement using continuous suture technique in patients with aortic valve disease. Korean J Thorac Cardiovasc Surg. 2013;46(4):249–55.CrossRefPubMedPubMedCentral Choi JB, Kim JH, Park HK, Kim KH, Kim MH, Kuh JH, et al. Aortic valve replacement using continuous suture technique in patients with aortic valve disease. Korean J Thorac Cardiovasc Surg. 2013;46(4):249–55.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Wu Z, Cao H, Zhu D, Wang Q, Wang D. Replacement of the st jude medical regent valve in the aortic position with a continuous suture technique in the small aortic root. J Card Surg. 2014;29(2):170–4. (11).CrossRefPubMed Wu Z, Cao H, Zhu D, Wang Q, Wang D. Replacement of the st jude medical regent valve in the aortic position with a continuous suture technique in the small aortic root. J Card Surg. 2014;29(2):170–4. (11).CrossRefPubMed
12.
Zurück zum Zitat Mikus E, Calvi S, Panzavolta M, Luis Zulueta J, Dozza L, Cavalucci A, et al. Right anterior mini-thoracotomy: a ‘new gold standard’ for aortic valve replacement? J Heart Valve Dis. 2015;24(6):693–8. 12.PubMed Mikus E, Calvi S, Panzavolta M, Luis Zulueta J, Dozza L, Cavalucci A, et al. Right anterior mini-thoracotomy: a ‘new gold standard’ for aortic valve replacement? J Heart Valve Dis. 2015;24(6):693–8. 12.PubMed
14.
Zurück zum Zitat Al-ghamdi B, Mallawi Y, Shafquat A, Ledesma A, AlRuwaili N, Shoukri M, et al. Predictors of permanent pacemaker implantation after coronary artery bypass grafting and valve surgery in adult patients in current surgical era. Cardiol Res. 2016;7(4):123–9.CrossRefPubMedPubMedCentral Al-ghamdi B, Mallawi Y, Shafquat A, Ledesma A, AlRuwaili N, Shoukri M, et al. Predictors of permanent pacemaker implantation after coronary artery bypass grafting and valve surgery in adult patients in current surgical era. Cardiol Res. 2016;7(4):123–9.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Leon MB, Smith CR, Mack MJ, Makkar RR, Svennson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.CrossRefPubMed Leon MB, Smith CR, Mack MJ, Makkar RR, Svennson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.CrossRefPubMed
16.
Zurück zum Zitat Bagur R, Manazzoni JM, Dumont É, Doyle D, Perron J, Dagenais F. Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis. Heart. 2011;97(20):1687–94.CrossRefPubMed Bagur R, Manazzoni JM, Dumont É, Doyle D, Perron J, Dagenais F. Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis. Heart. 2011;97(20):1687–94.CrossRefPubMed
17.
Zurück zum Zitat Sultan I, Siki M, Wallen T, Szeto W, Vallabhajosyula P. Management of coronary obstruction following transcatheter aortic valve replacement. J Card Surg. 2017;32(12):777–81.CrossRefPubMed Sultan I, Siki M, Wallen T, Szeto W, Vallabhajosyula P. Management of coronary obstruction following transcatheter aortic valve replacement. J Card Surg. 2017;32(12):777–81.CrossRefPubMed
18.
Zurück zum Zitat Mikus E, Turci S, Calvi S, Ricci M, Dozza L., Del giglio M. Aortic valve replacement through right minithoracotomy: is it really biologically minimally invasive? Ann Thorac Surg. 2015;99(3):826–30.CrossRefPubMed Mikus E, Turci S, Calvi S, Ricci M, Dozza L., Del giglio M. Aortic valve replacement through right minithoracotomy: is it really biologically minimally invasive? Ann Thorac Surg. 2015;99(3):826–30.CrossRefPubMed
19.
Zurück zum Zitat Niclauss L, Delay D, Pfister R, Colombier S, Kirsch M, Prêtre R. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. Asian Cardiovasc Thorac Ann. 2017;25(5):350–6.CrossRefPubMed Niclauss L, Delay D, Pfister R, Colombier S, Kirsch M, Prêtre R. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. Asian Cardiovasc Thorac Ann. 2017;25(5):350–6.CrossRefPubMed
20.
Zurück zum Zitat Rodriguez-Gabella T, Voisine P, Dagenais F, Mohammadi S, Perron J, Dumont E, et al. Long-term outcomes following surgical aortic bioprosthesis implantation. J Am Coll Card. 2018;17(31):1401–12.CrossRef Rodriguez-Gabella T, Voisine P, Dagenais F, Mohammadi S, Perron J, Dumont E, et al. Long-term outcomes following surgical aortic bioprosthesis implantation. J Am Coll Card. 2018;17(31):1401–12.CrossRef
Metadaten
Titel
A running suture line for aortic valve replacement does not increase the rate of postoperative complete heart block
verfasst von
Ibrahim Sultan
Keith A. Dufendach
Arman Kilic
Valentino Bianco
Forozan Navid
Thomas G. Gleason
Publikationsdatum
12.09.2018
Verlag
Springer Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-018-1011-1

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.