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

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.

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.

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.

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.