Abstract
Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers’ exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.
Highlights
The estimated prevalence of all valve diseases in adults is 2.5%, and the prevalence increases with age [1].The preferred surgical treatment for non-ischemic mitral valvular regurgitation is repair of the original valve [2]
This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement
There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement
Summary
The preferred surgical treatment for non-ischemic mitral valvular regurgitation is repair of the original valve [2]. If the mitral valve is non-repairable due to severe calcification or extensive leaflet destruction, a replacement of the valve is preferable [2]. The incidence of PPL/PVL detected by transesophageal echocardiography is up to 15% in the first postoperative period though small leaks in asymptomatic patients are found to be benign. These are followed by regular echocardiography to ensure that they do not worsen, in which case re-operation could be necessary [4]. The durability of the sutures and the operation technique used are important factors in preventing or creating PVL and thereby the risk of need for surgical revision
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