Katz N M, Blackstone E H, Kirklin J W, Bradley E L, Lemons J E
J Thorac Cardiovasc Surg. 1981 Apr;81(4):528-36.
Repair of the complete atrioventricular canal defect is still complicated by dehiscence of sutured atrioventricular valves. An in vitro study of initial suture line strength during tensile loading was made using canine pericardial leaflets. Type of "non-pledgetted" stitch was not related to suture line strength. Closer spacing of non-pledgetted stitches (1 mm versus 2 mm) increased strength 29% (p less than 0.05). Pledgets increased strength 25% (p = 0.004). Greater depth (3 mm versus 1.5 mm) increased strength 32% (p less than 0.0001) in both pledgetted and non-pledgetted stitches. Larger suture size (4-0 versus 6-0) increased strength minimally. An in vivo study was performed to determine if the positive effect of pledgets on initial stitch strength would persist in a functioning mitral valve during healing. Four incisions were made at the base of the anterior mitral leaflet in dogs and were closed with one horizontal mattress stitch, with or without pledgets. After 1 to 7 days, none of the 16 pledget-supported stitches had disrupted whereas nine of the 16 stitches without pledgets had torn out of the leaflet (p = 0.001). Tensile testing indicated use of pledgets resulted in stronger stitches (p = 0.0005). Results indicate that in the repair of the complete atrioventricular canal defect, pledget-supported sutures should be used. If non-pledgetted stitches are necessary, bites should be deep and closely spaced.
完全性房室通道缺损的修复仍因缝合的房室瓣裂开而复杂化。使用犬心包瓣叶对拉伸负荷下的初始缝线强度进行了体外研究。“无垫片”缝合类型与缝线强度无关。无垫片缝线间距更近（1毫米对2毫米）可使强度提高29%（p<0.05）。垫片可使强度提高25%（p = 0.004）。无论是有垫片还是无垫片的缝线，更大的深度（3毫米对1.5毫米）可使强度提高32%（p<0.0001）。更大的缝线尺寸（4-0对6-0）对强度的提高微乎其微。进行了一项体内研究，以确定垫片对初始缝线强度的积极影响在愈合过程中是否会在功能性二尖瓣中持续存在。在犬的二尖瓣前叶基部做四个切口，用一个水平褥式缝线缝合，有或没有垫片。1至7天后，16个有垫片支撑的缝线无一断裂，而16个无垫片的缝线中有9个从瓣叶上撕裂（p = 0.001）。拉伸试验表明使用垫片可使缝线更强（p = 0.0005）。结果表明，在完全性房室通道缺损修复中，应使用有垫片支撑的缝线。如果必须使用无垫片缝线，咬边应深且间距紧密。
