Conduction disturbances following surgical aortic valve replacement with a rapid-deployment bioprosthesis

Abstract

Background: The implantation of rapid-deployment aortic valves may interfere with the conduction system of the heart. This study evaluates the occurrence and predictive factors of conduction anomalies in patients undergoing surgical aortic valve replacement (SAVR) with a rapid-deployment balloon-expandable bioprosthesis in a single-center, real-world experience.Methods: Between May 2010 and April 2019, 700 consecutive patients were included in a prospective, ongoing database with a longitudinal follow-up preoperatively, at discharge, and at 3 months, 1 year, 3 years, and 5 years postoperatively. Thirty-seven patients (5.3%) had a permanent pacemaker at baseline and were excluded from further analysis, leaving 663 patients for analysis. Assessment of conduction anomalies was performed by electrocardiography (ECG) monitoring and repeated 12-lead ECG during the hospital stay and at postoperative follow-ups.Results: Preoperatively, 126 patients (19.0%) presented with different conduction disturbances. New permanent pacemaker implantation (PPI) occurred in 61 patients during the first 14 days (cumulative incidence, 9.4%). The indication for PPI was complete atrioventricular block in 47 cases (77%). Preoperative conduction anomalies, such as right bundle branch block, as well as operative characteristics (concomitant procedures) were found to be independent predictors for new PPI. One-year survival was 98% in patients with new early PPI and 96% in those without new early PPI (P ¼ .60). Conclusions:The PPI rate was in the range of previous reports for rapiddeployment prostheses. PPI did not have a significant influence on short-to intermediate-term survival. Case selection with exclusion of patients presenting with baseline conduction disturbances may decrease the rate of new PPIs after SAVR with rapid-deployment balloon-expandable bioprostheses.

Commentary: Pacemaker requirement with rapid-deployment aortic valves

“…The report by Coti and colleagues 1 is important in that it confirms the higher pacemaker implantation rate previously reported for RD valves. Although increased experience with these valves will undoubtedly lead to some moderation of the pacemaker rate, this risk is clearly one more factor that will have to be taken into account when considering the expanded options now available to treat aortic stenosis and in framing physician-patient discussion of these options.…”

Outcome of rapid deployment aortic valves: long-term experience after 700 implants

“…The meta-analysis from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR) (19) also showed a pacemaker rate of 10.4%. We recently published a detailed analysis of postoperative conduction disturbances of this population (20). Our intermediate-long term results did not show any significant influence on overall survival related to pacemaker implantation.…”

Direct comparison of rapid deployment versus sutureless aortic valve replacement: a meta-analysis

“…However, the SU valve has a self-expanding nature and will constantly compress the conduction pathway with a persistent outward force (30). Clinically, Coti et al (31) reported that preoperative right bundle branch block and concomitant procedures were the independent predictors for new pacemaker implantation after RDAVR. Despite significant differences in the primary outcomes, these differences did not translate into differences in secondary outcomes, such as early mortality, bleeding reoperation and stroke.…”