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Mitral Valve Replacement With Continuous Suture Technique
SUSHIL K. SINGH;
King George's Medical University, LUCKNOW, India
BACKGROUND: Mitral valve replacement (MVR) is most commonly performed surgery for stenotic and regurgitant lesions of mitral valve. Various suturing techniques for anchoring mechanical prosthetic mitral valve have been developed. We routinely perform mitral MVR using continuous suture technique. We find this approach to be faster with significant reduction in CPB time, aortic cross clamp time, ICU stay, comparable morbidity and mortality, and overall very cost effective.
METHODS: This prospective study was done from January 2020 through June 2023 included four hundred twenty two patients with chronic rheumatic mitral valve disease ( stenosis or regurgitation) undergoing isolated or combined mitral valve replacement with prosthetic mechanical valve. Patient with emergency surgeries, heavily calcified mitral apparatus, infective / ischaemic mitral valve were excluded from the study. PML was preserved in 374 patients while AML and PML both were preserved in 206 patients. Single 2 / 0 polypropylene with taper cut 26mm needle was used to anchor the valve at mitral annulus ( Figure 1). Clinical and echocardiographic follow up was done in OPD at 1, 3 and 6 months.
RESULTS: Four hundred twenty two
patients were included in the study. The average age of the patients was 31.54 years ± 10.42 years and consisted of 235 (55.69%) males and 187 (44.31%) females. Forty seven patients had undergone prior mitral valve intervention. Atrial fibrillation was present in 26.8% patients and left atrial clot was reported in 68 patients. Average CPB time was 45.54 ± 11.49 minutes and mean aortic cross-clamp time was 24.78 ± 8.81 minutes. Significant decrease in inotropic support, ventilator time, mediastinal drainage and shorter ICU stay were observed. Mediastinal drainage averaged 237.31 ± 168.56 ml whereas 1.04 ± 0.843 units of packed red blood cells were transfused. Incidence of paravalvular leak was 2.2%. Two patients had prosthetic valve dehiscence in the follow up. There were 3 peri-operative mortality.
CONCLUSIONS: MVR with continuous suture technique is safe and cost effective surgical technique without increase in morbidity or mortality. This technique has a better and faster post operative recovery mandating routine use of this technique
Figure 1: MVR using continuous suture techniqe
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