Non-pledget commissural suture technique to avoid atrioventricular block

General Thoracic and Cardiovascular Surgery (2021)Cite this article

Abstract

Here, we report our unique “non-pledget commissural suture technique” to avoid complete atrioventricular block during surgical aortic valve replacement, whereby all commissural stiches are made in a figure-of-eight fashion without a pledget. Then, standard stiches in a non-everting fashion are made using pledget sutures and a prosthetic valve is implanted at the supra-annular position. Among 152 evaluated patients, only five patients experienced complications, including three left bundle branch blocks, one postoperative pacemaker implantation, and one moderate paravalvular leak. Based on the high success rate, our technique may be a reasonable alternative for surgical aortic valve replacement.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

Fig. 1

References

  1. 1.

    Fadahunsi OO, Olowoyeye A, Ukaigwe A, Li Z, Vora AN, Vemulapalli S,et al. Incidence, predictors, and outcomes of permanent pcemaker implantation following transcatheter aortic valve replacement: analysis from the US society of thoracic surgeons/American college of cardiology TVT Registry. JACC Cardiovasc Interv. 2016;9:2189–99.

    Article  Google Scholar 

  2. 2.

    Matthews IG, Fazal IA, Bates MG, Turley AJ. In patients undergoing aortic valve replacement, what factors predict the requirement for permanent pacemaker implantation? Interact Cardiovasc Thorac Surg. 2011;12:475–9.

    Article  Google Scholar 

  3. 3.

    Uva MS. Transcatheter aortic valve implantation in low-risk patients: is it too early? Heart. 2019;105:s51–6.

    Article  Google Scholar 

  4. 4.

    Mehaffey JH, Haywood NS, Hawkins RB, Kern JA, Teman NR, Kron IL, et al. Need for permanent pacemaker after surgical aortic valve replacement reduces long-term survival. Ann Thorac Surg. 2018;106:460–5.

    Article  Google Scholar 

  5. 5.

    Totaro P, Calamai G, Montesi G, Barzaghi C, Vaccari M. Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement. J Card Surg. 2000;15:418–22.

    CAS  Article  Google Scholar 

  6. 6.

    González Barbeito M, Estévez-Cid F, Pardo Martínez P, Velasco García de Sierra C, IglesiasGil C, Quiñones Laguillo C, et al. Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses. J Thorac Dis. 2019;11:2945–3295.

    Article  Google Scholar 

  7. 7.

    Kim HH, Lee S, Joo HC, Kim JH, Youn YN, Yoo KJ, et al. Impact of suture techniques for aortic valve replacement on prosthesis-patient mismatch. Ann Thorac Surg. 2020;109:661–7.

    Article  Google Scholar 

  8. 8.

    Yanagisawa H, Tabata M. Modified annular suturing technique for minimizing postoperative pacemaker use after surgical aortic valve replacement. Gen Thorac Cardiovasc Surg. 2020;5:78.

    Google Scholar 

Download references

Acknowledgements

None

Funding

None.

Author information

Affiliations

  1. Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan

    Shingo Kunioka, Kishu Fujita, Shizuko Iwasa & Kenji Yamazaki

  2. Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan

    Hiroyuki Kamiya

  3. Department of Cardiothoracic Surgery, Excela Health Westmoreland Hospital, Greensburg, PA, USA

    Hiroyuki Tsukui

Authors
  1. Shingo Kunioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kishu Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shizuko Iwasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroyuki Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenji Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroyuki Tsukui
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shingo Kunioka.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kunioka, S., Fujita, K., Iwasa, S. et al. Non-pledget commissural suture technique to avoid atrioventricular block. Gen Thorac Cardiovasc Surg (2021). https://doi.org/10.1007/s11748-021-01605-5

Download citation

Keywords

  • Aortic valve replacement
  • Heart block
  • Permanent pacemaker