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Research Letter
November 21, 2018

Safety and Feasibility of a Nonpledgeted Suture Technique for Heart Valve Replacement

Author Affiliations
  • 1Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Surg. Published online November 21, 2018. doi:10.1001/jamasurg.2018.4243

One of the major complications of heart valve replacement is paravalvular leak (PVL). Large PVLs result in the progression of heart failure and endocarditis.1,2 Clinically significant PVL requiring reoperation occurs in fewer than 2% of cases.3 Traditionally, pledgeted, nonabsorbable sutures are used to secure prosthetic valves. The aim of this study was to assess the safety and feasibility of using nonpledgeted sutures for heart valve replacements.

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    1 Comment for this article
    Demonstration of standard surgical technique
    andrew muir, Mb BCh MRCS MD FRCS(CTh) | Liverpool Heart & Chest Hospital, Liverpool, England, UK.
    Dear sir,

    I have read with interest the description of this 'novel' technique, foregoing the use of pledgets in implanting replacement valves. I would contend that this is merely a routine form of surgical care rather than any type of innovation. My own cardiothoracic training began in 1999, and at that time included pledgetted interrupted, non-pledgetted interrupted (both simple sutures and mattress sutures) and semi-continuous as 3 equally valid implantation suturing techniques. In my current practice, my usual technique is a non-pledgetted interrupted horizontal mattress one, with pledgets being used ad hoc when I feel the annulus needs additional
    support (for instance with endocarditis which has encroached upon the annulus, or following extensive debridement of invasive calcification).
    Just like with OPCABG techniques, if you have not been exposed to a particular way of performing a strand of our specialty either as a trainee or once established, stepping away from your comfort zone is difficult, and will appear novel.
    I would recommend this technique to all surgeons for their valves, as in addition to not having to physically contend with the pledgets themselves, the ability to more freely vary stitch width can be of use when the commissure spacing in not uniform.

    Andrew D Muir.
    Consultant Cardiac Surgeon.