62 A meta analysis examining the incidence of permanent pacemaker implantation following sutureless aortic valve implantation

Abstract

BackgroundSutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation (TAVI). TAVI is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional SAVR.MethodsA systematic review was conducted in accordance with the Prisma guidelines (1). PubMed was searched by entering the following in the searching algorithm: sutureless AND aortic AND valve, tissue AND aortic AND valve, mechanical AND aortic AND valve. English was set as a language restriction. All searches were performed on August 10th2014.Studies between 2007 and 2014 were included in the search. A mixed-effects meta-regression with sutureless vs conventional as a fixed moderator variable was performed.ResultsIn total, 832 patients were included in the sutureless group and 3,740 in the conventional group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1 vs 2.4% p = 0.025). Cardiopulmonary bypass and aortic cross clamp times were shorter in the sutureless group (64.9 vs. 86.7 min p = 0.002, 39.8 vs. 62.4 min p < 0.001). No statistically significant differences in PVR grades 1–4 were identified between groups (Grade 1: 3.6 vs. 1.4% p = 0.107, Grade 2: 0.9 vs. 0.3% p = 0.264, Grade 3–4 0 vs. 0.4% p = 0.942). There was no difference in 30-day mortality between sutureless and conventional cohorts (1.9 vs. 3.2% p = 0.146).ConclusionSutureless aortic valve prostheses are associated with a higher incidence of PPM insertion but shorter implantation time than conventional, with no difference in 30-day mortality. Further investigation as to the prognostic significance of pacemaker requirement following sutureless aortic valve replacement is required.