[HSF] AORTIC VALVE REPLACEMENT

[V. Aldrete, M.D.]

Ed,

Totally agree with you.  The only issue is that knowing the experience  
of others with possible unexpected outcomes, litigation can be  
difficult to overcome, should this ever happen to you. Just an  
different perspective you may wish to consider.

Cheers,

Victor


On Mar 20, 2008, at 5:22 PM, Edward P Raines wrote:

> Victor,
>     I am certainly cognizant of the theoretical perils of both the  
> use of prolene and the technique but have not experienced any such  
> consequences to date.   As with many things we do, it may not only  
> be exactly what we do but how we do it.  In the final analysis, the  
> results and an honest assesmemt of patient outcomes is the most  
> important determinant.
>
>
>                               Ed
>
> Sent from my iPod
>
> On Mar 20, 2008, at 12:41 PM, "V. Aldrete, M.D."  
> <valdretemd at shaw.ca> wrote:
>
>>> 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
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