Sutureless Prosthesis Implant Technique: Impact on Postoperative Pacemaker Implantation Rate

Elisabet Berastegui garcia, Sara Badia Gamarra, Maria Luisa Camara Rosell, Luis Delgado Ramis, Claudio Fernandez Gallego, Ignasi Julià Almill, Anna Llorens Ferrer

Hospital Universitari Germans Trias i Pujol, Badalona, Spain

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

In high-risk patients with severe aortic stenosis, aortic valve replacement (AVR) with a sutureless Perceval prosthesis (SU-AVR) can be performed instead of conventional AVR or transcatheter aortic valve implantation. We sought to determine the incidence and predictors of new-onset complete atrioventricular block(NO-AVB) requiring permanent cardiac stimulation following SU-AVR.

METHODS: 373 consecutive patients who underwent SUAVR between January 2013 and November 2017 were studied. The initial technique consisted in partial aortic decalcification and subannular valve implantation, was employed in the first stage, n:107 patients. Modified technique with complete decalcification and intraanular valve deployment was employed in n 266 patients.

Predictive preoperative and procedural variables and electrocardiographic parameters were identified using a logistic regression model.

RESULTS: Mean age was 77 years old, 42.63 % male. Mean EuroScore 2 6,74 SD 8,39, 32,9% of patients underwent any concomitant procedure.

The most common postoperative conduction disturbances were LBBB (29%), NO-AVB (14.1%). The incidence of NO-AVB was 69,1 % lower with the modified versus the initial technique (p = 0.04). NO-AVB predominantly appeared within 24 h post-surgery, occurring >24 h post-surgery in only 6 patients (both with baseline conduction defects).

Independent preoperative predictors of NO-AVB included baseline left QRS axis deviation (LaQD p = 0.03), preoperative first-degree AVB (P < 0.01) and standard surgical implantation technique (P = 0.02).

CONCLUSIONS: NO-AVB is a frequent complication following SU-AVR, and its incidence strongly depends on the surgical implantation technique.

Preoperative first-degree AVB and LaQD independently predict NO-AVB and should be considered when deciding the duration of postoperative electrocardiographic monitoring.