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Non-pledget commissural suture technique to avoid atrioventricular block.

Shingo Kunioka1, Kishu Fujita2, Shizuko Iwasa2

  • 1Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan. kyokui090069@gmail.com.

General Thoracic and Cardiovascular Surgery
|February 20, 2021
PubMed
Summary

This study introduces a novel suture technique for surgical aortic valve replacement, significantly reducing the risk of atrioventricular block. The non-pledget commissural suture method offers a safe and effective alternative for patients undergoing this procedure.

Keywords:
Aortic valve replacementHeart blockPermanent pacemaker

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Medical Devices

Background:

  • Complete atrioventricular block is a significant risk during surgical aortic valve replacement.
  • Existing techniques may not fully mitigate this complication.
  • Minimizing surgical complications enhances patient outcomes.

Purpose of the Study:

  • To present and evaluate a novel "non-pledget commissural suture technique" for surgical aortic valve replacement.
  • To assess the efficacy of this technique in preventing complete atrioventricular block.
  • To determine the complication rates associated with this innovative surgical approach.

Main Methods:

  • A unique "non-pledget commissural suture technique" was employed, utilizing figure-of-eight stitches without pledgets at the commissures.
  • Standard non-everting pledget sutures were used for valve implantation in a supra-annular position.
  • The technique was applied to 152 patients undergoing surgical aortic valve replacement.

Main Results:

  • A low complication rate was observed in the 152 evaluated patients.
  • Only five patients experienced adverse events: three left bundle branch blocks, one instance of postoperative pacemaker implantation, and one moderate paravalvular leak.
  • The technique demonstrated a high success rate in avoiding complete atrioventricular block.

Conclusions:

  • The "non-pledget commissural suture technique" is a safe and effective method for surgical aortic valve replacement.
  • This approach significantly reduces the incidence of complete atrioventricular block.
  • The technique presents a viable alternative for surgeons performing aortic valve replacement.