Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA 22908-0679, USA.
J Thorac Cardiovasc Surg. 2011 Feb;141(2):388-93. doi: 10.1016/j.jtcvs.2010.04.011. Epub 2010 May 20.
The use of pledgeted sutures to secure the prosthetic valve to the annulus during aortic valve replacement is thought to decrease the incidence of paravalvular leak. We hypothesized that use of nonpledgeted sutures in aortic valve replacement would provide equivalent outcomes to those of a pledgeted suture technique.
Between January 1995 and April 2009, a total of 802 patients (511 nonpledgeted, 291 pledgeted) underwent isolated aortic valve replacement, including 671 patients who underwent primary, isolated aortic valve replacement (412 nonpledgeted, 259 pledgeted). Preoperative risk, intraoperative findings, and postoperative complications, including operative mortality, were evaluated.
Operative mortalities in isolated AVR operations were similar at 2.5% and 3.1% (P>.66) for nonpledgeted and pledgeted groups, respectively. Paravalvular leak rates after aortic valve replacement were equivalent in nonpledgeted and pledgeted groups (0.8% vs 1.4%, respectively, P=.47). Reoperation for paravalvular leak was rare in both groups. Importantly, the nonpledgeted technique incurred significantly shorter aortic crossclamp time (58.1±0.3 minutes vs 61.6±0.4 minutes, P<.001) and cardiopulmonary bypass time (87.5±0.8 minutes vs 90.3±0.8 minutes, P=.02) than did the pledgeted technique.
A nonpledgeted suture technique offers an equivalent alternative to the traditional use of pledgets during aortic valve replacement, with no increase in paravalvular leak rate. This nonpledgeted suture technique provides a time efficient and safe approach to aortic valve replacement operations.
在主动脉瓣置换术中，使用带垫片缝线将人工瓣膜固定在瓣环上被认为可以降低瓣周漏的发生率。我们假设在主动脉瓣置换术中使用无垫片缝线可以提供与垫片技术相当的结果。
1995 年 1 月至 2009 年 4 月，共有 802 例患者（511 例非垫片组，291 例垫片组）接受了单纯主动脉瓣置换术，其中 671 例患者接受了原发性单纯主动脉瓣置换术（412 例非垫片组，259 例垫片组）。评估了术前风险、术中发现和术后并发症，包括手术死亡率。
单纯主动脉瓣置换术的手术死亡率在非垫片组和垫片组分别为 2.5%和 3.1%（P>.66）。非垫片组和垫片组主动脉瓣置换术后瓣周漏发生率相当（分别为 0.8%和 1.4%，P=.47）。两组均很少因瓣周漏而再手术。重要的是，非垫片技术的主动脉阻断时间（58.1±0.3 分钟比 61.6±0.4 分钟，P<.001）和体外循环时间（87.5±0.8 分钟比 90.3±0.8 分钟，P=.02）明显短于垫片技术。
在主动脉瓣置换术中，非垫片缝线技术提供了一种与传统垫片使用等效的替代方法，不会增加瓣周漏的发生率。这种非垫片缝线技术为主动脉瓣置换手术提供了一种高效、安全的方法。
