[HSF] AORTIC VALVE REPLACEMENT

[Prasanna Simha M]

I was trained in this technique and it was the preferred methodin the
institute in which I trained. It is doable but going by literature
people have had a higher paravalvar leak rate. It may be due to
inattention todetails etc etc but the one thing is that if  a single
suture cuts through and unravels you end up with 1/3 annulus at risk.
That is the concern.
Prasanna

On Thu, Mar 20, 2008 at 10:30 AM,  <DukeB60 at aol.com> wrote:
> Gustavo,
>     I have replaced the aortic valve for the last 17  years with three 3-0
>  prolene sutures with the technique I learned from Donald  Doty and still do it
>  exactly as shown in his surgical atlas.  The argument  against is the fear of
>  perivalvular leak but I have not seen that issue if you  are careful to take
>  good bites and are diligent in debriding the annulus  and in snugging the
>  sutures down before tying them.  It is quicker,  allows the use of the suture for
>  retraction to gain visibility of the annulus  and I like only having to tie
>  three knots.   The only time I don't use  the technique (maybe once or twice) is
>  if the annulus is very calcified and  can't be debrided adequately and I fear
>  the calcium cutting the prolene.   You have to be careful not to ever grasp or
>  fracture the prolene but with  the right technique I have found it to be a
>  very reliable approach.
>
>
>
>                                       Ed
>
>  Edward P. Raines, M.D., J.D.
>  BryanLGH  Cardiothoracic Surgery
>  BryanLGH Medical Center East
>  1600 South 48th  Str.
>  Lincoln, Nebraska 68506
>  Office: 402-481-8430
>  Cell:  402-730-9242
>  Fax: 402-481-8429
>
>
>
>  In a message dated 3/19/2008 8:14:48 P.M. Central Daylight Time,
>
> gabuin at intramed.net writes:
>
>  Dears  members of the forum.
>  I ussually perform my aortic valve replacement using  2-0 not pledgetted
>  sutures of Ethibond.
>  Sometimes (large annullus) I  use pledgetted sutures.
>  What´s your preffered  technique?
>  Why?
>
>  Does any of the members of the forum replace the  aortic valve with prolene
>  in with 6  2-0 prolene sutures?
>  If so,  why?
>  Thanks
>  gustavo
>
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-- 
Prasanna Simha M