[HSF] AORTIC VALVE REPLACEMENT

[Prasanna Simha M]

I haven't had paravalvar leaks in the post op echoes. I use
intraventricular pledgets if the annulus looks like it is thin and
friable and otherwise not pledgets.I actually have had a paravalavar
leak with the everting suture technique once 9detected immediately
post op) and revised - the pledgeted suture had cut through the
annulus !!
Prasanna

On Thu, Mar 20, 2008 at 4:17 PM, Dr. Roberto Battellini
<battr at medizin.uni-leipzig.de> wrote:
> Very good comment on the pannus problem, do you have (I am sure not)
>  paravalvular leaks without pledgets?
>  With intraventricular pledgets (I put 12 stitches for a 21 valve, 15 for a
>  23 and 25 valve, etc) I had only one case detected intraoperatively by TEE
>  in the last 5 years, the sutured valve was a 23 and she got after a 25 (same
>  OP).(of course, if I have others in the late postop, I cannot say it).
>  To avoid a 19 I use sometimes 18 single stitches, very careful, to put a 21
>  works good.Never a 19, then patch.
>
> Roberto
>
>  -----Ursprüngliche Nachricht-----
>  Von: openheart-l-bounces at lists.hsforum.com
>  [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna Simha
>  M
>  Gesendet: Donnerstag, 20. März 2008 02:22
>  An: OpenHeart-L at lists.hsforum.com
>  Betreff: Re: [HSF] AORTIC VALVE REPLACEMENT
>
>
>
>  2/0 nonpledgetted sutures each arm passed from LVOT side to aortic
>  side of the annulus. I used to use the classical everting pledgetted
>  sutures before but changed as I observd that you can consistently put
>  a larger size valve and I have anecdotal experience that it reduces
>  tha amount of Pannus. One thing is that the aortic annular rim must be
>  kept thin by meticulous excision with this technique.
>  When I was training we used to use the continuous prolene suture
>  technique which I feel should not be used as there is documentation of
>  a higher paravalvar leak rate.I think a ddramatic example was the case
>  which was presented to me at Croatia  where a patient had multiple
>  redos of the mitral vavle and the last one done in a London Hosptal
>  was done with a 2/0 Prolene 3 suture continuous technique and
>  developed a late paravalvar leak years after the original surgeryand
>  there was suture dehiscence.
>  Prasanna
>
>  On Thu, Mar 20, 2008 at 6:39 AM, gustavo abuin <gabuin at intramed.net> wrote:
>  > 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
>  >
>  >  _______________________________________________
>  >  OpenHeart-L mailing list
>  >
>  >  Send postings to:
>  >   OpenHeart-L at lists.hsforum.com
>  >
>  >  To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>  >  http://mmp.cjp.com/mailman/listinfo/openheart-l
>  >
>  >  All messages transmitted by the OpenHeart-L are subject to the policies
>  and
>  >  disclaimers posted at:
>  >  http://www.hsforum.com/listdisclaim
>  >  -----------------------------------------
>  >
>
>
>
>  --
>  Prasanna Simha M
>  _______________________________________________
>  OpenHeart-L mailing list
>
>  Send postings to:
>   OpenHeart-L at lists.hsforum.com
>
>  To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>  http://mmp.cjp.com/mailman/listinfo/openheart-l
>
>  All messages transmitted by the OpenHeart-L are subject to the policies and
>  disclaimers posted at:
>  http://www.hsforum.com/listdisclaim
>  -----------------------------------------
>
>  _______________________________________________
>  OpenHeart-L mailing list
>
>  Send postings to:
>   OpenHeart-L at lists.hsforum.com
>
>  To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>  http://mmp.cjp.com/mailman/listinfo/openheart-l
>
>  All messages transmitted by the OpenHeart-L are subject to the policies and
>  disclaimers posted at:
>  http://www.hsforum.com/listdisclaim
>  -----------------------------------------
>



-- 
Prasanna Simha M