Mitral Para-valvular leakage following usage of non-pledgeted compared to Teflon-pledgeted sutures

Ihab Mohamed Salah El Din Elsharkawy; Mohamed Abdalsalam Shaban; Hosam Fathy Ali Sayed; Ahmed H. Lamloom

doi:10.53730/ijhs.v6nS9.12990

Authors

Ihab Mohamed Salah El Din Elsharkawy
bebosharkawy@gmail.com
Department of Cardiothoracic Surgery, Cairo University, Faculty of Medicine, Cairo, Egypt
Mohamed Abdalsalam Shaban Department of Cardiothoracic Surgery, Cairo University, Faculty of Medicine, Cairo, Egypt
Hosam Fathy Ali Sayed Department of Cardiothoracic Surgery, Cairo University, Faculty of Medicine, Cairo, Egypt
Ahmed H. Lamloom Department of Cardiothoracic Surgery, Cairo University, Faculty of Medicine, Cairo, Egypt

Keywords:

Mitral valve replacement, Non-pledgeted sutures, Aortic cross clamp time and para-valvular leakage

Abstract

Background: Despite a wide variety of mitral prosthesis suturing, pledgeted annular sutures are preferred to lower the incidence of para-valvular leakage (PVL). However, there is limited evidence in the literature on the effect of non-plegeted sutures on such serious complication. Objective: The purpose of this study was to determine the safety and practicality of employing non-pledgeted sutures for Mitral valve replacement (MVR), especially regarding postoperative PVL. Patients and methods: Data on 100 patients with MVR were gathered from Cairo University Hospitals. Cases were split into two groups: group 1 underwent surgery using non-pledgeted horizontal sutures where in group 2 we used Teflon-pledgeted sutures. Preoperative, operative, and postoperative factors including follow-up echocardiographic examination one year following discharge, were compared between the two groups. Results: Both groups had similar preoperative characteristics, with group 1 including 49 patients compared to 51 patients in group 2. Data showed significantly shorter cross clamping (AXC) time in group 1 (p value < 0.05), intraoperative TEE has never observed para-prosthetic leakage in both groups, there was no significant difference regarding both mean ICU and hospital stay.

Downloads

Download data is not yet available.

References

Ionescu A, Fraser AG, Butchart EG.Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography.Heart. 2003; 89:1316–1321

Kliger C, Eiros R, Isasti G, Einhorn B, Jelnin V, Cohen H et al. Review of surgical prosthetic paravalvular leaks: diagnosis and catheter-based closure. Eur Heart J 2013 ;34 :638 –48.

De Cicco G, Russo CF, Moreo A, Beghi C, Fucci C, Gerometta P et al. Mitral valve periprosthetic leakage: anatomical observations in 135 patients from a multicentre study. Eur J Cardiothorac Surg 2006; 30:887 –91.

Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement.N Engl J Med. 2012; 366:1686–1695.

Duncan BF, McCarthy PM, Kruse J, Andrei AC, Li Z, Russell HM, et al. Paravalvular regurgitation after conventional aortic and mitral valve replacement:A benchmark for alternative approaches. J Thorac Cardiovasc Surg. 2015; 150:860–8.

Chan PG, Chan EG, Seese L, et al. Safety and Feasibility of a Nonpledgeted Suture Technique for Heart Valve Replacement. JAMA Surg. 2019;154(3):260–261.

Luca Botta, Benedetta De Chiara, Salvina Quattrocchi, Francesca Casadei, Francesco Borgia, Cristina Giannattasio, Antonella Moreo, Claudio Francesco Russo, Mitral periprosthetic leakage: contemporary results of surgical correction at a single centre, Interactive CardioVascular and Thoracic Surgery. 2017;25(2):185–19.

Hyun Jung Koo, Joo Yeon Lee, Gun Ha Kim, Joon-Won Kang, Young-Hak Kim, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Jae-Kwan Song, Tae-Hwan Lim, Dong Hyun Yang, Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features, European Heart Journal - Cardiovascular Imaging. 2018;19(12):1419–1427.

LaPar DJ, Ailawadi G, Bhamidipati CM, et al. Use of a nonpledgeted suture technique is safe and efficient for aortic valve replacement. J Thorac Cardiovasc Surg. 2011;141(2):388-393.

Tabata M, Shibayama K, Watanabe H, Sato Y, Fukui T, Takanashi S. Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis. J Thorac Cardiovasc Surg. 2014;147(1):321-325.

Vlessis AA, Khaki A, Grunkemeier GL, Li HH, Starr A. Risk, diagnosis and management of prosthetic valve endocarditis: a review. J Heart Valve Dis. 1997;6:443–65.

Kim GJ, Lee JT, Lee YO, Cho JY, Oh TH. Outcomes of nonpledgeted horizontal mattress suture technique for mitral valve replacement. Korean J Thorac Cardiovasc Surg. 2014 Dec;47(6):504-9. doi: 10.5090/kjtcs.2014.47.6.504. Epub 2014 Dec 5. PMID: 25551070; PMCID: PMC4279844.

Cappelli F, Del Bene MR, Santoro G, Meucci F, Attanà P, Barletta G. The challenge of integrated echocardiographic approach in percutaneous closure of paravalvular leak. Echocardiography. 2011;28: E168–71.

Ozan Gürsoy M, Kalçık M, Özkan M, Astarcıoğlu MA, Karakoyun S, Gündüz S, et al. Evaluation of Aortic Paravalvular Leak:A Special Reference for Anatomical Localization. J Heart Valve Dis. 2016; 25:403–9.

Gürsoy MO, Güner A, Kalçık M, Bayam E, Özkan M. A comprehensive review of the diagnosis and management of mitral paravalvular leakage. Anatol J Cardiol. 2020 Dec;24(6):350-360.

Dziubek M, Pierrakos C, Chebli L, Demanet H, Sanoussi A, Wauthy P. Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period. Curr Cardiol Rev. 2018 Mar 14;14(1):15-24.