Comparison of interrupted and semi-continuous suture techniques in rheumatic valvular disease by analysis of paravalvular regurgitation following mitral valve replacement: A retrospective cohort study.

Abstract

Objective: To compare o fboth interrupted and continuous technique following mitral valve replacement in terms of paravalvular regurgitation in patients with rheumatic heart diseases. Study Design: Retrospective Cohort study. Setting: Peshawar Institute of Cardiology, Peshawar. Period: 01/01/2022 to 31/12/2024. Methods: Analyzed 110 patients (46 males, 41.8%; 64 females, 58.2%) with a mean age of 39.8 ± 11.5 years and mean BMI of 23.3 ± 4.2, all of whom underwent isolated MVR for rheumatic pathology. Patients were grouped based on the suture technique used: semi-continuous or interrupted. Outcomes assessed included operative mortality, New York Heart Association (NYHA) functional class, PVR severity, and cross-clamp time. Results: Operative mortality was identical in both groups, with 1 patient each (0.9%), accounting for a total mortality of 1.8% (p = 1.0). Most patients were categorized as NYHA Class I or II postoperatively, representing 44.0% and 50.5% of the overall cohort, respectively. NYHA Class III occurred in 1.8% of the semi-continuous group and 3.7% of the interrupted group. PVR rates were comparable between techniques, with any-degree PVR observed in 44.5% of the semi-continuous group and 41.8% of the interrupted group. Moderate-to-severe PVR was slightly more prevalent in the semi-continuous group (1.8%) compared with the interrupted group (0.9%); however, this difference was not statistically significant (p = 0.5). Mean aortic cross-clamp time was significantly shorter for the semi-continuous technique (68.75 ± 22.2 minutes) than the interrupted technique (91.7 ± 27.3 minutes). Conclusion: Semi-continuous and interrupted suture techniques demonstrate comparable efficacy in preventing paravalvular regurgitation following rheumatic MVR, with no significant differences in operative mortality or postoperative functional class. The semi-continuous technique, however, offers the advantage of reduced cross-clamp time. Further prospective studies are warranted to validate these findings and explore long-term outcomes.