Pledgeted versus nonpledgeted sutures in aortic valve replacement: insights from a prospective multicenter trial

Velders, B.J.J.; Vriesendorp, M.D.; Sabik, J.F.; Dagenais, F.; Labrousse, L.; Bapat, V.; ... ; Klautz, R.J.M. (2023)

Article / Letter to editor

Objective: The objective of this study was to compare short-and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement. Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical end-points and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (< 23 mm) and suturing techniques were performed. Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences. Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run.

• pledgets
• surgical aortic valve replacement
• suturing technique
• thromboembolism
• endocarditis
• paravalvular leak

• All authors: Velders, B.J.J.; Vriesendorp, M.D.; Sabik, J.F.; Dagenais, F.; Labrousse, L.; Bapat, V.; Aldea, G.S.; Anyanwu, A.C.; Cai, Y.P.; Klautz, R.J.M.
• Date: 2023-02-01
• Journal: JTCVS TECHNIQUES
• Volume: 17
• Pages: 23 - 46
• DOI: doi:10.1016/j.xjtc.2022.10.016