Outcomes of Pledgeted versus Nonpledgeted Suture Technique for Isolated Aortic Valve Replacement

Objective: To compare outcomes of pledgeted versus nonplegdeted suture techniques for aortic valve replacement (AVR). Methods: This was a retrospective study utilizing an institutional database of AVRs performed at our center between 2010 and 2020. All patients who underwent isolated surgical AVR were included, while those who underwent concomitant procedures were excluded. Patients were dichotomized into those who underwent pledgeted vs. nonpledgeted AVR, and 1:1 propensity score matching (PSM) was employed. Clinical and echocardiographic outcomes were compared. Kaplan-Meier survival estimation and Cox regression were performed. Cumulative incidence functions were generated for all-cause readmissions and for heart-failure readmissions. Freedom from major adverse cardiac and cerebrovascular events (MACCE) were also analyzed and compared using Kaplan-Meier methods. Results: A total of 2240 patients were identified. PSM yielded 892 matched pairs. Mean gradient was significantly higher in the pledgeted group (p < 0.001), but patients in this group had a smaller median valve size implanted. There were no significant differences in paravalvular leak rates. Kaplan-Meier survival estimates, cumulative incidence of readmissions, and freedom from MACCE were not significantly different between groups. Conclusion: Long-term survival, readmission rates, and freedom from MACCE are comparable after pledgeted and nonpledgeted AVR. There were no differences in paravalvular leak rates between the two techniques.