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Geoffrey M. Stiles, MD; Jules A. Kernen, MD; Quentin R. Stiles, MD

Arch Surg. 1986;121(10):1136-1140.

Abstract
• To evaluate suture techniques for mitral valve replacement, 60 fresh porcine hearts were used to determine suture holding strength. Using four techniques (simple interrupted, figure-of-eight, and horizontal without and with pledgets), the anterior leaflet, the posterior leaflet, and the commissures were sutured. The free ends of the sutures were then attached to a force transducer, and tension was increased until disruption occurred. In the anterior leaflet, horizontal mattress sutures disrupted with significantly less force than the other techniques. Pledgets increased the holding strength of mattress sutures, but figure-of-eight and simple interrupted sutures had greater holding strength than sutures with pledgets, suggesting that the direction of the suture vs that of tissue fibers is critical. Histologic studies confirmed this point. The posterior leaflet exhibited less holding strength than the anterior leaflet for all suture techniques but did not demonstrate a superiority for any specific technique. The posterior leaflet is the problem area for suture disruption from the mitral anulus. We secure mitral prostheses with horizontal mattress sutures with pledgets around the entire anulus, placing them from the atrial side.

(Arch Surg 1986;121:1136-1140)

Author Affiliations
From the Department of Surgery, Los Angeles County—University of Southern California Medical Center (Drs G. M. Stiles and Q. R. Stiles); and the Department of Pathology, Hospital of the Good Samaritan, Los Angeles (Dr Kernen).

Footnotes
Accepted for publication July 29, 1986.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, Jan 17, 1986.

Reprint requests to 1245 Wilshire Blvd, Los Angeles, CA 90017 (Dr Q. R. Stiles).

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