Pledgeted Versus Nonpledgeted Sutures in Aortic Valve Replacement: Insights from a Prospective Multicenter Trial

Overview

Journal JTCVS Tech

Date 2023 Feb 23

PMID 36820352

Authors

Bart J J Velders

Michiel D Vriesendorp

Joseph F Sabik 3rd

Francois Dagenais

Louis Labrousse

Vinayak Bapat

Gabriel S Aldea

Anelechi C Anyanwu

Yaping Cai

Robert J M Klautz

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study was to compare short- and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement.

Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical endpoints and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (<23 mm) and suturing techniques were performed.

Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group ( = .51). The effective orifice area was smaller in the pledgeted group ( = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences.

Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run.

Citing Articles

The use of pledget-reinforced sutures during surgical aortic valve replacement: A systematic review and -analysis.

Taco Boltje J, Carvalho Mota M, Vriesendorp M, Vonk A, Groenwold R, Klautz R Int J Cardiol Heart Vasc. 2024; 54:101494.

PMID: 39263410 PMC: 11387225. DOI: 10.1016/j.ijcha.2024.101494.

Continuous or interrupted pledgeted suture technique in stented bioprosthetic aortic valve replacement: a comparison of in-hospital outcomes.

Arabkhani B, Gonthier S, Lorenz V, Deschamps S, Jahanyar J, Boute M J Cardiothorac Surg. 2024; 19(1):174.

PMID: 38576006 PMC: 10996201. DOI: 10.1186/s13019-024-02754-3.

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