Modified Park's Stitch Using Initial Systematic Cusp Alignment in Patients With Left Ventricular Assist Device

We describe a modified Park's stitch technique incorporating systematic free margin alignment to achieve complete elimination of aortic regurgitation in patients with a left ventricular assist device. The technique involves a two-step approach: first, free margin alignment of all three cusps using single interrupted 6-0 polypropylene sutures placed at the nodules of Arantius to achieve precise coaptation, followed by conventional Park's stitch using mattress sutures with autologous pericardial pledgets for central closure. The alignment sutures remain in place to provide reinforcement. This modification addresses the central redundancy created by prolapsing or elongated cusps while maintaining the theoretical advantages of Park's stitch. In six consecutive patients (mean age, 56.5 years; 66.7% destination therapy), complete elimination of aortic insufficiency was immediately achieved with a median cross-clamp time of 30.5 min (interquartile range, 26.8-41.3 min). At follow-up (median, 8 months), five of the six patients had maintained zero regurgitation, while the remaining patient had developed only trivial regurgitation. This systematic approach to free margin alignment before Park's stitch may offer improved durability compared with conventional techniques, particularly for destination therapy patients requiring extended support.