title: Suture technique does not affect hemodynamic performance of the small supra-annular Trifecta bioprosthesis.
abstract: OBJECTIVE
  The study objective was to evaluate whether aortic valve replacement with the Trifecta valve (St Jude Medical Inc, St Paul, Minn) using simple sutures produces better hemodynamic performance than valve replacement with noneverting pledget-reinforced sutures.
  
  
  METHODS
  We analyzed prospectively acquired 1-year hemodynamic data of patients with small aortic annulus sizes who were enrolled in a multicenter trial of the Trifecta aortic valve bioprosthesis and underwent aortic valve replacement with a 19-mm or 21-mm bioprosthesis between August 2007 and November 2009. We compared preoperative clinical information and 1-year postoperative hemodynamic data for noneverting pledget-reinforced sutures (group 1) versus everting mattress sutures or simple sutures (group 2).
  
  
  RESULTS
  A total of 346 patients underwent aortic valve replacement: 269 in group 1 and 77 in group 2. Preoperative demographic characteristics for the 2 groups were similar. For groups 1 and 2, the mean gradient was 10.4±4.7 mm Hg and 11.1±4.4 mm Hg for 19-mm valves, respectively, and 8.4±3.5 mm Hg and 8.8±3.6 mm Hg for 21-mm valves, respectively; the effective orifice area was 1.40 cm2 and 1.25 cm2 for 19-mm valves, respectively, and 1.57 cm2 and 1.50 cm2 for 21-mm valves, respectively. The rate of severe prosthesis-patient mismatch (indexed effective orifice area≤0.65 cm2/m2) was 18.6% (n=11) and 25% (n=6) for 19-mm valves, respectively, and 10.9% (n=20) and 16.3% (n=8) for 21-mm valves, respectively.
  
  
  CONCLUSIONS
  The suture method did not affect hemodynamic performance of supra-annular bioprostheses in patients with small aortic annulus sizes. Choice of suture technique should be determined by surgeon experience and local anatomic features.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Murat
authors: M
authors: Ugur
authors: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors: John G
authors: JG
authors: Byrne
authors: Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors: Joseph E
authors: JE
authors: Bavaria
authors: Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Anson
authors: A
authors: Cheung
authors: Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
authors: Michael
authors: M
authors: Petracek
authors: Cardiovascular and Thoracic Surgery, Mission Health, Asheville, NC.
authors: Mark A
authors: MA
authors: Groh
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Rakesh M
authors: RM
authors: Suri
authors: Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
authors: Michael A
authors: MA
authors: Borger
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: schaff@mayo.edu.
authors: Hartzell V
authors: HV
authors: Schaff
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D013536:Suture Techniques; D016896:Treatment Outcome