Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses

Abstract

Background: The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. Methods: Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/ intraoperative characteristics. The influence of the modified technique was analysed. Results: Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008).Conclusions: In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.

Aortic Valve Replacement Via Right Anterior Mini-Thoracotomy: the Conventional Procedure Performed Through a Smaller Incision

“…For this reason, we place that prosthesis as high as possible, but respecting the implant recommendations. In an in press paper, we reported a patient-prosthesis mismatch (PPM) rate of 2,3%; if we look at the available data on the need for permanent pacemaker in Perceval S series, we find rates ranging from 8 to 23%; after having adopted surgical tricks, the authors found a PPM rate of 4.3% [ 8 ] .…”

Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study

“…In this study, we report the feasibility and short‐term safety of LBBAP in patients with conduction disorders following valvular interventions. The main findings of our study are 1 : LBBAP was successfully accomplished in 95% of patients 2 ; LBBAP resulted in significantly narrower QRS duration compared to baseline QRS and was able to normalize activation in LBBB patients as well 3 ; pacing parameters were stable during a mean follow‐up of 8 months; and 4 acute and chronic complication rates were low. To the best of our knowledge, this is the largest series of LBBAP for patients with recent valvular interventions.…”

“…As such, atrioventricular block (AVB) is a common complication in patients postvalvular interventions (percutaneous or surgical). The incidence of AVB ranges from 5% to 30% in patients undergoing transcatheter aortic valve replacement (TAVR), 5% to 10% in patients undergoing surgical aortic valve replacement (SAVR), about 25%–30% in patients following tricuspid valve replacement (TVR) and 5%–10% in patients receiving mitral valve repairment or mitral valve replacement (MVR) 2,3 …”

Incidence and predictors of permanent pacemaker implantation after surgical aortic v alve replacement: Data of the Netherlands Heart Registration (NHR)

“… 10 Also, the absence of preoperative sinus rhythm has been reported as predictors for PPI after valvular surgery. 9 Gonzales Barbeito et al 30 in their series of 519 patients undergoing SAVR with a PERCEVAL S sutureless prosthesis identified disorders of intraventricular conduction and right bundle branch block as predictors for postoperative PPI. In their analysis, atrial fibrillation was not investigated as rhythm disturbances leading to PPI.…”