Influence of suture technique in aortic valve replacement on occurrence of "Prosthesis-Patient" mismatch

Objective. To determine the suture technique, which provides better hemodynamic indices in aortic valve replacement. Aortic valve AV) pathology is a widespread pathology among elderly persons and since the share of them increases every year, the number of surgeries for AV replacement is growing. Many factors can influence the hemolytic characteristics of AV prosthesis including construction of cusps and supporting ring. Suture technique can also influence the hemodynamic results of AV replacement. Conventional technique for attaching mechanical valve is an interrupted sealing suture.

Materials and methods. Patients who underwent AV prosthetics isolated prosthetics, prosthetics combined with coronary artery bypass grafting, with mitral valve repair, tricuspid valve repair or aortic prosthetics) over the period from January 2015 to September 2018 were studied. All statistical calculations were fulfilled using IBM SPSS Statistics 23.0 IBM Corp., Armonk, NY).

Results. Altogether, from January 2015 to September 2018, 439 patients underwent AV prosthetics; 321 patient 73.1 %) underwent isolated AV replacement. Unsealed technique had less frequency of occurrence of “prosthesis-patient" mismatch PPM), especially in the small aortic ring compared with the other suturing techniques. The suture type was the following: sealing and figure-of-eight suture and the number of sutures more than 16 were the risk factors for moderate and severe PPM in logistic regressive analysis; the suture technique was an independent risk factor for moderate and severe PPM.

Conclusions. An interrupted mattress unsealed suture permits to implant the AV prosthesis on the native fibrous ring of the valve with less frequency of occurrence of “prosthesis-patient" mismatch and promotes improvement of hemodynamics in patients with a small fibrous ring of the aortic valve.