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Flat-Plane AVR With Single Interrupted Sutures
Kazuo Tanemoto, Hiroshi Furukawa.
Kawasaki Medical School, Kurashiki, Japan.

Background - While the aortic valve annulus has a scalloped shape, the sewing cuff of the prosthetic valve is nearly flat. Some cases of coronary orifice obstruction due to tissue valve have been reported. This is caused by force-fitting the flat prosthetic valve to the scalloped annulus of the aortic valve. Using our flat-plane AVR technique, we could achieve safe implantation, without distortion of the sinus of Valsalva. Methods - Our surgical technique involves placing single interrupted sutures and keeping the suture line flat to fit the prosthetic valve, and avoid changing the shape of the sinus of Valsalva / blocking the coronary orifice. At each of the three commissures, it is necessary to suture, adopting the 2-0 polyester double-armed mattress suture method using reinforced materials, from outside the sinus of Valsalva beneath the commissure, in order to create a flat suture line. Then, 21 interrupted sutures are placed (Figure). We compared the balance (prosthetic valve size used minus the annular diameter assessed by preoperative echocardiography) achieved by this technique with that in cases operated by the conventional mattress suture technique. Results - A total of 43 cases were operated upon using this technique. The mean balance was 1.5 ± 0.2 mm, which was larger as compared with that (0.5 ± 0.2 mm; p = 0.004) in cases treated by mattress suture technique. The postoperative 3D-CT showed preserved shape of the sinus of Valsalva. Conclusion - We could resolve the discrepancy in shape between the aortic annulus and the prosthetic valves by placing the suture line in flat plane. Moreover, we could implant larger prosthetic valves. In cases with tissue valve failure in the future in which the valve-in-valve treatment is considered, the greater distance between the prosthetic valve and the coronary orifice obtained by this technique would be beneficial.

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