[HSF] AORTIC VALVE REPLACEMENT

Fri Mar 21 15:56:21 EDT 2008

Ani,
      I use interrupted 2-0 Ethibond (I think) horizontal matress non- 
pledgitted sutures for mitral and tricuspid rings and pledgetted  
sutures for replacement.  The reason for the difference with the  
aortic is the three commisure anatomic configuration of the aortic  
annulus which lends itself perfectly to the three sutures technique.   
The only reason for prolene is that it doesn't cut when it slides  
through the annular tissue and slides more easily than braided  
material.  Using Doty's method the scalloped bottom of the annulus is  
pulled by the pledget located in the mid-portion of the annulus up to  
the valve and orients the valve commissures of a tissue valve to the  
native commisure so the valves seats beautifully without any risk of  
obstructing the coronary ostia.  The mitral and tricuscid annulus are  
anatomically totally distinct and don't lend themselves to the  
technique.  Doty did a running mitral technique too in my training but  
I never liked it nor did it make any sense or have any apparent  
benefit so I NEVER run mitrals, rather repairing with the use of a  
ring.  Lawrie uses a running suture for his flexible mitral Tailor  
rings but I don't like the spacing of sutures with his method so have  
stuck with mattress interrupted in that instance.

           Ed

Sent from my iPod

On Mar 21, 2008, at 9:37 AM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:

> Dr Raines
>
> Do you use the same semicontinuous technique for mitral and  
> tricuspids? If not what is the basis for choice of different  
> techniques in those valves?
>
> Thanks
>
> Ani
>
>
>
>
>> From: DukeB60 at aol.com> Date: Thu, 20 Mar 2008 00:00:51 -0400>  
>> Subject: Re: [HSF] AORTIC VALVE REPLACEMENT> To: OpenHeart-L at lists.hsforum.com 
>> > CC: > > 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 sut 
>> ures?> If so, why?> Thanks> gustavo> > ___________________________ 
>> ____________________> OpenHeart-L mailing list> > Send postings to 
>> :> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE emai 
>> l 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 
>> > -----------------------------------------> > > > > > *********** 
>> ***Create a Home Theater Like the Pros. Watch the video on AOL > H 
>> ome. > (http://home.aol.com/diy/home-improvement-eric-stromer?video=15?ncid=aolhom00030000000001 
>> )> _______________________________________________> OpenHeart-L ma 
>> iling 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 
>> > -----------------------------------------
> _________________________________________________________________
> Amazing prizes every hour with Live Search Big Snap
> http:// 
> www.bigsnapsearch.com_______________________________________________
> 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
> -----------------------------------------