When a valve prosthesis is to be implanted in the aortic position, simple interrupted suture, figure-ofeight suture, or horizontal mattress suture technique is used as a suture method. However, the suture techniques may be unacceptable for aortic
valve
replacement in patients with friable annulus caused by some lesions, such as endocarditis and degenerative change. We uscd an alternative technique for the aortic vlave replacement in 4 patients with valve endocarditis, 3 patients with
degenerative
valvular lesion, and 1 with rheumatic valvular disease. Mattress sutures through the annulus were placed with pledgets on the ventricular side of the annulus, which resulted in implantation of the prosthesis at a supra-annular level. Mechanical
valves
of 21 mm or larger were implanted in the supra-annular position in all patients and there was no impeded motion of leaflets during the follow-up period of mean 13.3 months. The transvalvular pressure gradient was less than 6 mm Hg in 3 patients
and
20
to 40 mm Hg in 5 patients. The supra-annular implantation of mechanical aortic valve using a vertical mattress suture technique may be a useful alternative method of aortic valve replacement for the selected patients with friable or destroyed
aortic
annulus.
|