The EPMS technique showed no clinical benefit compared to other methods in aortic valve replacement, despite shorter clamp times and higher postoperative gradients.
Does the everting, pledgeted mattress suture (EPMS) technique improve clinical outcomes or valve hemodynamics compared to other techniques in patients undergoing isolated aortic valve replacement?
The everting, pledgeted mattress suture technique for aortic valve replacement does not provide clinical or hemodynamic benefits over standard suturing techniques, with shorter operative times likely reflecting specific surgeon expertise.
Absolute Event Rate: 0% vs 0%
Objective To determine whether the use of everting, pledgeted mattress suture (EPMS) technique for aortic valve replacement is advantageous compared to other commonly used techniques. Methods From January 2002 to January 2022, 709 isolated aortic valve replacements were performed using the EPMS technique, and 3749 replacements were completed using other techniques. After propensity‐matching for aortic valve size and prosthesis type, demographics, patient profile, valve pathophysiologic disorders, and echocardiographic measurements, 641 well‐matched pairs were identified. Primary endpoints were the prevalence of stroke, paravalvular leak, and postoperative valve gradient. Secondary endpoints were in‐hospital clinical outcomes, left ventricular (LV) remodeling, reoperations, and survival. Results There was no significant difference in stroke (5 0.78% vs. 10 1.6%, p = 0.19) or paravalvular leak (3 0.47% vs. 3 0.47%, p > 0.9) between EPMS and non‐EPMS groups, respectively. The EPMS group had shorter clamp times (median: 39 vs. 54 min, p < 0.0001), similar length of hospital stay, and operative mortality (1.0% vs. 0.69%, p = 0.52). Postoperative gradients were higher in the EPMS group (16 vs. 15 mmHg at 1 year, and 21 vs. 17 mmHg at 10 years, p = 0.01). There was no difference in temporal trends of postoperative LV mass index, freedom from reoperation, or survival. In patients with prior cardiac surgery, the EPMS group had shorter clamp times (median: 41 vs. 55 min, p < 0.0001), a lower prevalence of postoperative atrial fibrillation (27 19% vs. 47 35%, p = 0.005), and less renal failure (0 0% vs. 5 2.6%, p = 0.03). Other outcomes did not differ significantly between groups. Conclusion EPMS for aortic valve replacement did not show benefit over other techniques. Although there is a small but statistically significant difference in postoperative valve gradients, it is not clinically significant. Shorter operating times along with better clinical outcomes are likely more reflective of specific surgeon expertise than the type of suture technique.
Štembal et al. (Thu,) reported a other. The EPMS technique showed no clinical benefit compared to other methods in aortic valve replacement, despite shorter clamp times and higher postoperative gradients.