[HSF] AORTIC VALVE REPLACEMENT

[V. Aldrete, M.D.]

> Hi Ed,

You may wish to read the citations below in relation to the use of  
prolene sutures.
Prolene suture fracture is not an unknown issue and 3-0 sutures may be  
at higher risk than heavier sutures.

Victor

> Annals of Thoracic Surgery. 1984 Mar;37(3):264
> Annals of Thoracic Surgery. 1983 35:170
>> 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