title: Outcomes of nonpledgeted horizontal mattress suture technique for mitral valve replacement.
abstract: BACKGROUND
  Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL.
  
  
  METHODS
  We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups.
  
  
  RESULTS
  In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant.
  
  
  CONCLUSIONS
  We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital.
authors.forename: Gun Jik
authors.initials: GJ
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital.
authors.forename: Jong Tae
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital.
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital.
authors.forename: Tak-Hyuk
authors.initials: TH
authors.lastname: Oh
keywords: Mitral valve, replacement; Morbidity; Suture techniques