Document Detail


Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT).
MedLine Citation:
PMID:  16275007     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine risk factors for major paravalvular leak (PVL) events after mechanical heart valve replacement. METHODS: We analyzed outcome of 807 patients randomized into the Artificial Valve Endocarditis Reduction Trial (AVERT). The mean follow-up time was 30.6 months and 21 major PVL events were reported. Three additional major PVL events associated with endocarditis were excluded from analysis. All baseline medical history variables, as well as operative parameters (including use of pledgets and suture technique) were examined using Cox regression. RESULTS: Major PVL was reported after 11 aortic, 9 mitral, and 1 double valve replacement. 6/404 (1.5%) patients with conventional valves experienced a major PVL event versus 15/403 (3.7%) in the Silzone group. 10/172 (5.8%) patients with valve suture technique without pledgets experienced a major PVL event versus 11/635 (1.7%) patients with pledgets. Final multivariable model showed that only suture technique without pledgets (p=0.005) was an independent significant risk factor for major PVL events. Silzone cuff showed a strong trend (p=0.055). CONCLUSIONS: Suture technique without pledgets is an independent significant risk factor for major PVL events. In this study, use of pledgets during valve replacement had a protective effect against subsequent paravalvular leak, supporting the use of buttress reinforcement for valve suture. The use of Silzone cuff, although not statistically significant, showed a strong trend as a risk factor.
Authors:
Lars Englberger; Hartzell V Schaff; W R Eric Jamieson; Elizabeth D Kennard; Kyung A Im; Richard Holubkov; Thierry P Carrel;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-11-07
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  28     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-05     Completed Date:  2006-03-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  838-43     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Inselspital, University Hospital, Freiburgstrasse, 3010 Berne, Switzerland. lars.englberger@insel.ch
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve / surgery
Coated Materials, Biocompatible
Endocarditis, Bacterial / etiology,  prevention & control
Female
Follow-Up Studies
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / instrumentation,  methods
Humans
Male
Middle Aged
Mitral Valve / surgery
Prosthesis Failure*
Risk Factors
Silver / therapeutic use
Suture Techniques
Chemical
Reg. No./Substance:
0/Coated Materials, Biocompatible; 7440-22-4/Silver
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2005 Dec;28(6):843-4   [PMID:  16325134 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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