A running suture line for aortic valve replacement does not increase the rate of postoperative complete heart block

• Published in: General thoracic and cardiovascular surgery 2019-03, Vol.67 (3), p.283-288
• Main Authors: Sultan, Ibrahim, Dufendach, Keith A., Kilic, Arman, Bianco, Valentino, Navid, Forozan, Gleason, Thomas G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Valve - surgery; Atrioventricular Block - etiology; Cardiac Surgery; Cardiology; Cohort Studies; Ejection fraction; Endocarditis; Female; Heart; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Humans; Ischemia; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Pacemakers; Patients; Propensity Score; Prostheses; Radiation; Surgical Oncology; Suture Techniques - adverse effects; Sutures; Thoracic Surgery; Young Adult
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-018-1011-1

Background Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker. Methods 374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017. Patients with preoperative heart block, patients undergoing concomitant MAZE procedure and those undergoing multivalve procedures were excluded. Interrupted technique was performed with multiple non-pledgeted sutures. Running technique was performed with three 2–0 polypropylene sutures. Propensity-score matching (caliper distance = 0.10) was used to match based on patient age, gender, BMI, diabetes mellitus, renal failure, heart failure, arrythmias, use of anti-arrhythmics, and STS PROM. Results Propensity score matching yielded 103 pairs of running technique and interrupted technique patients for analysis. Within the propensity score-matched cohort, there were no differences in sustained complete heart block and need for pacemaker, 4 (3.8%) for running technique vs 3 (2.9%) for interrupted technique ( p  = 0.307). At 4 weeks, there was no difference in mean prosthetic aortic valve gradients calculated on transthoracic echocardiogram (6.39 ± 2.47 mmHg vs 6.46 ± 2.86, p  = 0.850). There was no difference in paravalvular leak (0 (0%) vs 2 (1.9%), p  = 0.070). Conclusions Surgical implantation of a prosthetic aortic valve may be performed with a running suture technique without any significant increase in risk of heart block, need for permanent pacemaker or paravalvular leak. Long-term data will be critical to evaluate any development of paravalvular leaks in the future.