AW: [HSF] AORTIC VALVE REPLACEMENT

[Tea Acuff]

So now we are back to the mechanism of pannus. Is it a suture technique problem, since it not related to interaction between prosthesis and LVOT, Ani?

tea



----- Original Message ----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, March 20, 2008 5:47:57 AM
Subject: AW: [HSF] AORTIC VALVE REPLACEMENT

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
>
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-- 
Prasanna Simha M
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