Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis

Objective: A supra-annular aortic valve prosthesis is often used for aortic valve replacement in patients with a small aortic annulus. However, which suture technique provides the best valve performance has not been studied. We aimed to compare valve performance between 2 different suture techniques. Methods: We reviewed 152 patients undergoing aortic valve replacement with a 19- or 21-mm Carpentier-Edwards Perimount Magna aortic bioprosthesis (Edwards Lifesciences, Irvine, Calif) between June 2008 and December 2010. Simple interrupted sutures were used in 102 patients (group A, 19-mm prosthesis in 47 patients and 21-mm prosthesis in 55 patients), and noneverting mattress sutures were used in 50 patients (group B, 19-mm prosthesis in 20 patients and 21-mm prosthesis in 30 patients). Transthoracic echocardiograms were performed at baseline and before discharge in all patients and 1 year after surgery in 141 patients. We compared the effective orifice area and incidence of prosthesis-patient mismatch (effective orifice area index <0.85 cm ²/m²) between 2 groups. Results: The mean postoperative effective orifice areas were 1.41 ± 0.32 cm²/m² in group A and 1.30 ± 0.28 cm²/m² in group B (P =.025). The incidence of prosthesis-patient mismatch was 29% in group A and 56% in group B (P =.002). A multivariate analysis has shown that simple interrupted suturing is a negative predictor of prosthesis-patient mismatch (odds ratio, 0.33; 95% confidence interval, 0.13-0.83; P =.018). At 1 year, the incidence of prosthesis-patient mismatch was 27% in group A and 47% in group B (P =.023). Conclusions: Simple interrupted sutures provide larger effective orifice areas and reduce the incidence of prosthesis-patient mismatch after aortic valve replacement with a small supra-annular bioprosthesis. This suture technique is preferred in those patients to maximize valve performance.