Puluca Nazan, Münsterer Andrea, Prinzing Anatol, Sexton Zachary A, Lange Rüdiger, Meyer-Saraei Roza, Scharfschwerdt Michael
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany.
Insure (Institute for Translational Cardiac Surgery) Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany.
J Thorac Dis. 2020 May;12(5):2443-2449. doi: 10.21037/jtd.2020.03.55.
The aim of this study was to evaluate the hemodynamic effect of different suturing techniques for aortic valve replacement (AVR) . Whether or not the applied suturing technique impacts the outflow tract diameter by narrowing the annulus diameter was examined.
The commonly applied non-everting pledget forced suture technique (NE, n=13) was compared with an everting pledget forced suture (ET, n=13) for AVR using the 25 mm St. Jude Trifecta aortic valve. Hemodynamic parameters were obtained in a pulsatile flow simulator. A high speed camera captured the visual aspects of the suturing technique.
Despite some kind of left ventricular outflow narrowing due to protruding pledgets using the NE suture technique, mean pressure gradients of both techniques were nearly similar (NE 5.88±2.7 mmHg, ET 5.23±1.31 mmHg, P=0.44). Closing volume (NE 3.16±0.48 mL; ET 3.51±0.68 mL; P=0.14) and the leakage volume (NE: 8.09±2.53 mL; ET: 8.35±3.65 mL; P=0.83) also showed no differences.
AVR using either suturing techniques leads to a similar hemodynamic performance . The impact of the suturing technique may be higher in a smaller annulus. Therefore, further studies using smaller prostheses are necessary.
本研究的目的是评估不同缝合技术用于主动脉瓣置换术（AVR）的血流动力学效果。研究了所应用的缝合技术是否会通过缩小瓣环直径而影响流出道直径。
使用25mm圣犹达Trifecta主动脉瓣，将常用于AVR的非外翻带垫片强制缝合技术（NE，n = 13）与外翻带垫片强制缝合技术（ET，n = 13）进行比较。在脉动流模拟器中获取血流动力学参数。高速摄像机记录了缝合技术的视觉情况。
尽管使用NE缝合技术时由于带垫片突出导致左心室流出道有所狭窄，但两种技术的平均压力梯度几乎相似（NE 5.88±2.7mmHg，ET 5.23±1.31mmHg，P = 0.44）。闭合容积（NE 3.16±0.48mL；ET 3.51±0.68mL；P = 0.14）和漏血容积（NE：8.09±2.53mL；ET：8.35±3.65mL；P = 0.83）也无差异。
采用任何一种缝合技术进行AVR均能产生相似的血流动力学表现。在较小的瓣环中，缝合技术的影响可能更大。因此，有必要使用更小的人工瓣膜进行进一步研究。
