Stiles G M, Kernen J A, Stiles Q R
Arch Surg. 1986 Oct;121(10):1136-40. doi: 10.1001/archsurg.1986.01400100042008.
To evaluate suture techniques for mitral valve replacement, 60 fresh porcine hearts were used to determine suture holding strength. Using four techniques (simple interrupted, figure-of-eight, and horizontal without and with pledgets), the anterior leaflet, the posterior leaflet, and the commissures were sutured. The free ends of the sutures were then attached to a force transducer, and tension was increased until disruption occurred. In the anterior leaflet, horizontal mattress sutures disrupted with significantly less force than the other techniques. Pledgets increased the holding strength of mattress sutures, but figure-of-eight and simple interrupted sutures had greater holding strength than sutures with pledgets, suggesting that the direction of the suture vs that of tissue fibers is critical. Histologic studies confirmed this point. The posterior leaflet exhibited less holding strength than the anterior leaflet for all suture techniques but did not demonstrate a superiority for any specific technique. The posterior leaflet is the problem area for suture disruption from the mitral anulus. We secure mitral prostheses with horizontal mattress sutures with pledgets around the entire anulus, placing them from the atrial side.
为评估二尖瓣置换术的缝合技术，使用60个新鲜猪心来测定缝合的固定强度。采用四种技术（单纯间断缝合、8字缝合、不带垫片和带垫片的水平褥式缝合）对前叶、后叶和瓣环进行缝合。然后将缝线的游离端连接到力传感器上，逐渐增加张力直至缝线断裂。在前叶，水平褥式缝合线断裂所需的力明显小于其他技术。垫片增加了褥式缝合的固定强度，但8字缝合和单纯间断缝合的固定强度大于带垫片的缝合，这表明缝线方向与组织纤维方向至关重要。组织学研究证实了这一点。对于所有缝合技术，后叶的固定强度均低于前叶，但未显示出任何特定技术的优越性。后叶是二尖瓣环缝线断裂的问题区域。我们在整个瓣环周围使用带垫片的水平褥式缝合从心房侧固定二尖瓣假体。
