Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective
Objective: The objective of this study was to compare short- and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement. Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a pr...
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| Language: | English |
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Elsevier
2023-02-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722005429 |
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| author | Bart J.J. Velders, MD Michiel D. Vriesendorp, MD Joseph F. Sabik, III, MD Francois Dagenais, MD Louis Labrousse, MD Vinayak Bapat, MD Gabriel S. Aldea, MD Anelechi C. Anyanwu, MD Yaping Cai, MS Robert J.M. Klautz, MD, PhD |
| author_facet | Bart J.J. Velders, MD Michiel D. Vriesendorp, MD Joseph F. Sabik, III, MD Francois Dagenais, MD Louis Labrousse, MD Vinayak Bapat, MD Gabriel S. Aldea, MD Anelechi C. Anyanwu, MD Yaping Cai, MS Robert J.M. Klautz, MD, PhD |
| author_sort | Bart J.J. Velders, MD |
| collection | DOAJ |
| description | Objective: The objective of this study was to compare short- and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement. Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical endpoints and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (<23 mm) and suturing techniques were performed. Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences. Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run. |
| format | Article |
| id | doaj-art-ae9dfa181ecd46c0ba898edebb32f435 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-ae9dfa181ecd46c0ba898edebb32f4352025-08-20T03:36:37ZengElsevierJTCVS Techniques2666-25072023-02-0117234610.1016/j.xjtc.2022.10.016Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspectiveBart J.J. Velders, MD0Michiel D. Vriesendorp, MD1Joseph F. Sabik, III, MD2Francois Dagenais, MD3Louis Labrousse, MD4Vinayak Bapat, MD5Gabriel S. Aldea, MD6Anelechi C. Anyanwu, MD7Yaping Cai, MS8Robert J.M. Klautz, MD, PhD9Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Address for reprints: Bart J. J. Velders, MD, Department of Cardiothoracic Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, The Netherlands.Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the NetherlandsDepartment of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OhioDivision of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, CanadaMedico-Surgical Department of Valvulopathies, Bordeaux Heart University Hospital, Bourdeaux-Pessac, FranceDepartment of Cardiothoracic Surgery, NHS Foundation Trust–St Thomas' Hospital, London, United KingdomDepartment of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, WashDepartment of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NYCore Clinical Solutions, Medtronic, Mounds View, MinnDepartment of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the NetherlandsObjective: The objective of this study was to compare short- and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement. Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical endpoints and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (<23 mm) and suturing techniques were performed. Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences. Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run.http://www.sciencedirect.com/science/article/pii/S2666250722005429pledgetssurgical aortic valve replacementsuturing techniquethromboembolismendocarditisparavalvular leak |
| spellingShingle | Bart J.J. Velders, MD Michiel D. Vriesendorp, MD Joseph F. Sabik, III, MD Francois Dagenais, MD Louis Labrousse, MD Vinayak Bapat, MD Gabriel S. Aldea, MD Anelechi C. Anyanwu, MD Yaping Cai, MS Robert J.M. Klautz, MD, PhD Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective JTCVS Techniques pledgets surgical aortic valve replacement suturing technique thromboembolism endocarditis paravalvular leak |
| title | Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective |
| title_full | Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective |
| title_fullStr | Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective |
| title_full_unstemmed | Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective |
| title_short | Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trialCentral MessagePerspective |
| title_sort | pledgeted versus nonpledgeted sutures in aortic valve replacement insights from a prospective multicenter trialcentral messageperspective |
| topic | pledgets surgical aortic valve replacement suturing technique thromboembolism endocarditis paravalvular leak |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722005429 |
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