{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:58Z","timestamp":1753876318775,"version":"3.41.2"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T00:00:00Z","timestamp":1649116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Surgical aortic valve replacement (SAVR) in small annuli carries an elevated risk for the patient\u2013prosthesis mismatch. In this study, we systematically investigated the influence of different implantation techniques including annular enlargement (AE) on the functional result after SAVR in small annuli using a standardized ex vivo model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>SAVR using the PERIMOUNT Magna Ease\u00ae (PME) 21 mm was performed in small porcine aortic roots using 4 implantation techniques: non-everting pledgeted (NE) suture, single interrupted (SI) suture, continuous suture (CS), figure-of-8 (F8) suture, as well as the PME 23 mm after AE using the Nunez method and the NE suture technique (PME23 AE). The effective orifice area (EOA), mean pressure gradient and leakage volume were evaluated using a mock circulation loop in accordance with ISO regulations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Experiments were conducted on 31 porcine aortic roots. PME21 using F8 and PME23 after AE achieved a significantly larger EOA than using NE. PME23 after AE showed a larger EOA than the PME21 using any suture technique, except the F8 [for stroke volume of 74 ml: PME21 NE: 1.68 (1.63\u20131.72) cm2, PME21 SI: 1.76 (1.68\u20131.81) cm2 (P = 0.17), PME21 CS: 1.76 (1.65\u20131.79) cm2 (P = 0.14), PME21 F8: 1.81 (1.70\u20131.85) cm2 (P = 0.005); PME23 AE: 1.83 (1.73\u20131.92) cm2 (P &amp;lt; 0.001)]. SI and CS did not result in larger EOA compared with the NE technique. PME21 using SI had a significantly larger leakage volume than using NE and there was no significant difference between other techniques [for stroke volume of 74 ml: PME21 NE: 3.51 (1.85\u20134.53) ml\/stroke, PME21 SI: 6.00 (4.02\u20137.06) ml\/stroke (P &amp;lt; 0.001), PME21 CS: 4.04 (3.60\u20134.49) ml\/stroke (P = 0.10), PME21 F8: 3.16 (1.99\u20133.62) ml\/stroke (P = 0.74), PME23 NE: 2.89 (2.45\u20134.72) ml\/stroke (P = 0.51)].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The F8 technique with the PME21 achieved a similar EOA as the 1 size larger PME23 using NE after AE. These results suggest that the F8 technique may be an effective surgical modification to improve the haemodynamic result in a small annulus without additional AE.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezac195","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T20:10:13Z","timestamp":1647375013000},"source":"Crossref","is-referenced-by-count":3,"title":["The figure-of-8 aortic valve suturing technique optimizes the effective orifice area of a small aortic annulus\u2014an <i>ex vivo<\/i> study"],"prefix":"10.1093","volume":"62","author":[{"given":"Hiroyuki","family":"Saisho","sequence":"first","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"Kuhlmann","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-6703","authenticated-orcid":false,"given":"Michael","family":"Scharfschwerdt","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0043-9924","authenticated-orcid":false,"given":"Reuben","family":"Jeganathan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Royal Victoria Hospital , Belfast, Northern Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najla","family":"Sadat","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Schaller","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas","family":"Aboud","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9508-3261","authenticated-orcid":false,"given":"Stephan","family":"Ensminger","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Buntaro","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein , L\u00fcbeck Campus, Germany"},{"name":"University of L\u00fcbeck , L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,4,5]]},"reference":[{"key":"2022082912583417900_ezac195-B1","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","author":"Vahanian","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022082912583417900_ezac195-B2","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"2022082912583417900_ezac195-B3","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1093\/ejcts\/ezx408","article-title":"Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients","volume":"53","author":"Fujita","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022082912583417900_ezac195-B4","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1055\/s-0032-1332704","article-title":"Isolated aortic valve replacement in patients with small aortic annulus-a high-risk group on long-term follow-up","volume":"61","author":"Wilbring","year":"2013","journal-title":"Thorac Cardiovasc Surg"},{"key":"2022082912583417900_ezac195-B5","first-page":"404","article-title":"Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications","volume":"18","author":"Bahlmann","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2022082912583417900_ezac195-B6","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/S0735-1097(00)00859-7","article-title":"Hemodynamic and clinical impact of prosthesis\u2013patient mismatch in the aortic valve position and its prevention","volume":"36","author":"Pibarot","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2022082912583417900_ezac195-B7","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2459\/JCM.0000000000000292","article-title":"Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients?","volume":"17","author":"Sportelli","year":"2016","journal-title":"J Cardiovasc Med"},{"key":"2022082912583417900_ezac195-B8","doi-asserted-by":"crossref","first-page":"366","DOI":"10.2459\/JCM.0000000000000508","article-title":"Impact of different values of prosthesis-patient mismatch on outcome in male patients with aortic valve replacement","volume":"18","author":"Mannacio","year":"2017","journal-title":"J Cardiovasc Med"},{"key":"2022082912583417900_ezac195-B9","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jtcvs.2012.11.020","article-title":"Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis","volume":"147","author":"Tabata","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022082912583417900_ezac195-B10","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/S0022-5223(19)38105-X","article-title":"Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique","volume":"78","author":"Manouguian","year":"1979","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022082912583417900_ezac195-B11","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/01.MAT.0000137038.03251.35","article-title":"The influence of a nonlinear resistance element upon in vitro aortic pressure tracings and aortic valve motions","volume":"50","author":"Scharfschwerdt","year":"2004","journal-title":"ASAIO J"},{"year":"2015","author":"DIN EN ISO 5840-1. Cardiovascular Implants\u2014Cardiac Valve Prostheses. Part 1: General Requirements. Genf, Switzerland: International Organisation for Standardization","key":"2022082912583417900_ezac195-B12"},{"key":"2022082912583417900_ezac195-B13","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1136\/hrt.2005.067363","article-title":"Prosthesis-patient mismatch: definition, clinical impact, and prevention","volume":"92","author":"Pibarot","year":"2006","journal-title":"Heart"},{"key":"2022082912583417900_ezac195-B14","doi-asserted-by":"crossref","first-page":"390","DOI":"10.14503\/THIJ-16-5886","article-title":"Continuous suture technique for aortic valve replacement shortens cross-clamp and bypass times","volume":"44","author":"Kitamura","year":"2017","journal-title":"Tex Heart Inst J"},{"key":"2022082912583417900_ezac195-B15","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.athoracsur.2019.09.012","article-title":"Impact of suture techniques for aortic valve replacement on prosthesis-patient mismatch","volume":"109","author":"Kim","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2022082912583417900_ezac195-B16","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.jtcvs.2013.12.006","article-title":"Suture technique does not affect hemodynamic performance of the small supra-annular Trifecta bioprosthesis","volume":"148","author":"Ugur","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022082912583417900_ezac195-B17","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/icvts\/ivw015","article-title":"Multicentre, propensity-matched study to evaluate long-term impact of implantation technique in isolated aortic valve replacement on mortality and incidence of redo surgery","volume":"22","author":"Haqzad","year":"2016","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2022082912583417900_ezac195-B18","doi-asserted-by":"crossref","first-page":"332","DOI":"10.5090\/kjtcs.20.066","article-title":"Simple interrupted suturing for aortic valve replacement in patients with severe aortic stenosis","volume":"53","author":"Lee","year":"2020","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"2022082912583417900_ezac195-B19","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.athoracsur.2020.03.064","article-title":"Suture techniques and patient-prosthesis mismatch for aortic valve surgery","volume":"110","author":"Iscan","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2022082912583417900_ezac195-B20","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/S0003-4975(97)00127-6","article-title":"Aortic valve replacement with patch enlargement of the aortic annulus","volume":"63","author":"Sommers","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"2022082912583417900_ezac195-B21","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1016\/j.athoracsur.2019.04.118","article-title":"Incremental risk of annular enlargement: a multi-institutional cohort study","volume":"108","author":"Hawkins","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2022082912583417900_ezac195-B22","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.1161\/CIRCULATIONAHA.118.038408","article-title":"Aortic stenosis and small aortic annulus","volume":"139","author":"Freitas-Ferraz","year":"2019","journal-title":"Circulation"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/62\/3\/ezac195\/45612192\/ezac195.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/62\/3\/ezac195\/45612192\/ezac195.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T12:59:37Z","timestamp":1661777977000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezac195\/6563500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,5]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezac195","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2022,9,1]]},"published":{"date-parts":[[2022,4,5]]},"article-number":"ezac195"}}