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Single Interrupted Suturing for Redo Mitral Valve Replacement Provides an Appropriate Prosthesis Size and Comparable Early Clinical Outcomes
Hiroshi Furukawa, Tekashi Honda, Noriaki Kuwada, Takahiko Yamasawa, Kazuo Tanemoto.
Kawasaki Medical School, Kurashiki, Japan.

Backgound: The purpose of this study was to evaluate the early clinical outcomes and efficacy of single interrupted suturing for redo mitral valve replacement (MVR). Methods: Of 334 mitral valve surgery patients, 20 consecutive patients (12 women and 8 men, mean age 66±11 years, ranging from 32 to 80) who underwent redo MVR in our institute between 2000 and 2013 participated in this study. The surgical indications for redo MVR were paravalvular leakage (PVL) in 10 patients, prosthetic valve endocarditis (PVE) in 5, mechanical valve thrombosis in 3, and structural bioprosthesis deterioration in 2. The number of previous surgeries was one in 10 patients, two in 6, and three in 4. Emergent or urgent surgeries were performed in 5 patients. Sharp dissection was initially performed on one side of the previous prosthetic sewing-cuff and the overall sewing-cuff was thereafter completely removed following leaflet detachment. Results: The surgical procedure was successfully performed in all patients without any serious complications. Single interrupted suturing with a mean number of 32.7±3.0 sutures, ranging from 28 to 40, was performed to implant the new valve without exposing the rough surface of the mitral valve annulus, thereby allowing for the eventual implantation of larger prostheses. Bioprostheses were selected in 10 patients and mechanical valves in 10 patients. Fifteen patients (75.0%) were able to receive the same- or larger-sized new prosthesis than that of previous surgeries. No patients exhibited postoperative residual PVL or PVE. The operative mortality (30-days) was 5.0%, which was similar to that of MVR (n=78): 2.6% (p=0.57). Conclusions: Single interrupted suturing for re-do MVR may allow for the implantation of larger prostheses and this novel maneuver may achieve acceptable early clinical outcomes.

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