Two-Year Incidence of Permanent Pace-Maker Implantation Post Modified SAVR

Abstract

Background and Aim of this Study: Patients presenting with aortic stenosis are offered surgical aortic valve (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating PPMI. We evaluate in this paper the impact of a modified technique of SAVR- which aims to decrease the stress on the conduction system- on the incidence of PPMI for a 24 months period post-surgery. Methods: The perioperative course of 184 patients who underwent SAVR in Saint George Hospital University Medical center between January 2016 and June 2019 was assessed. The study compares the incidence of PPMI between two groups of patients. In group A, 92 patients underwent the classic SAVR and in-group B, and 92 patients underwent a modified SAVR. Results: The results revealed a significant decrease of PPMI from 12 to 2.2% during a two-year period follow up. A multi variate analysis showed that the modified technique was a strong predictor for PPMI post SAVR. In addition, this rate (2.2%) was lower than the ones reported after TAVR. Conclusion: This reproducible and reliable technique should be recommended whenever SAVR is performed. On the other hand, the low incidence observed may be adopted as a benchmark whenever TAVR is offered as a therapeutic option specially to intermediate and low risk patients. Moreover, this less traumatic technique should be retained whenever stent design modifications for TAVR are considered.