Effect of Valve Suture Technique on Incidence of Paraprosthetic Regurgitation and 10-Year Survival

Abstract

The primary objective was to estimate the risk of paraprosthetic regurgitation (PPR) after aortic (AVR) and mitral valve replacement (MVR) using interrupted (IN) or semicontinuous (SC) sutures. The secondary objective was to estimate the risk of redo valve surgery and 10-year survival after valve replacement performed using either suture technique. Patients who underwent mechanical AVR or MVR using a St. Jude prosthesis between December 1991 and June 1997 were included. Eighteen patients had MVR and 43 had AVR using IN sutures; 49 and 83 patients received MVR and AVR, respectively, using SC sutures. The majority of these patients were part of a randomized controlled trial with different end points, presented elsewhere. Patients were followed for 10 years with annual transthoracic echocardiography, and clinical data were collected retrospectively. Kaplan-Meier survival analysis was performed. Cox's regression analysis was performed to identify factors predicting mortality as a function of time. Forward stepwise logistic regression was performed to analyze risk factors predicting PPR. Mann-Whitney U test was used for continuous and nonparametric data, and chi2 test and Fisher's exact test were used for categorical data. A probability value less than 0.05 was considered significant. The overall risk of PPR after MVR and AVR was higher in the SC group than in the IN group. The need for redo AVR was significantly higher in the SC group. The suture technique did not affect the 10-year survival after either AVR or MVR. Use of SC technique increases the risk of significant PPR after AVR and MVR compared with IN technique independent of the size of prosthesis, degree of annular calcification, disease of the excised valve, or the implanting surgeon. Although 10-year survival is independent of suture technique, SC technique increases the risk of redo valve replacement after AVR.