Continuous Suture Technique and Impairment of the Atrioventricular Conduction After Aortic Valve Replacement

Abstract

Objective: Atrioventricular (AV) conduction impairment represents an infrequent complication following aortic valve replacement (AVR). Although several conditions have been considered as potential risk factors for such a postoperative event, the role of the surgical technique has not been evaluated. The aim of this study was to investigate if the suture technique for implantation of the prosthetic valve is a potential risk factor need of pacemaker (PM) implantation after AVR. Methods: One hundred twenty‐four patients undergoing AVR were enrolled in this study. A “continuous” suture technique was performed in 72 patients (58%; Group A), whereas an “interrupted” suture technique was used in 52 patients (42%; Group B). The incidence of “major,” requiring PM implantation, as well as “minor,” without PM implantation, impairment of the AV conduction was evaluated and compared in the two groups by means of univariate and multivariate analyses. Results: The patients of the two groups were homogenous for all preoperative parameters except patient age. A longer clamp time was present in the patients of group B than those of group A (73 ± 24 minutes and 60 ± 24 minutes, respectively; p < 0.01). Postoperatively, hospital mortality consisted of four patients (3.2%) with no statistical importance between the two groups. Eleven patients of group A (17.5%) and one patient of group B (2.2%) required PM implantation (p < 0.05). Prolonged P‐R interval was recorded in 15 patients of group A and in 5 patients of group B (p < 0.05). Conclusions: We showed that the continuous suture technique increases the need for postoperative PM implantation after AVR. No major differences have been observed, however, regarding in‐hospital mortality and length of hospital stay, regardless of the type of prosthetic suture technique.

Complete atrioventricular block after isolated aortic valve replacement

“…Similar observations were made by Keefe et al [6] while Totaro et al [7] found that valve prosthesis implantation using semicontinuous sutures was associated with more frequent occurrence of complete AV block. Duration of both cardiopulmonary bypass and aortic cross-clamp was significantly higher in Group A in both univariate analysis and by univariate and multivariate logistic regression (Tables 2-4).…”

Need for Permanent Pacemaker as a Complication of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Elderly Patients With Severe Aortic Stenosis and Similar Baseline Electrocardiographic Findings

“…PPI after SAVR. The occurrence of conduction disturbances and the need for PPI is a well-known complication after cardiac surgery (17)(18)(19)(20)(21)(22), but most studies including SAVR patients have also included coronary artery bypass grafting as a concomitant intervention. Keefe et al (18) and Dawkins et al (22) reported a PPI rate of 3.3% and 8.5%, respectively, after isolated SAVR.…”

“…Although some studies have already identified several variables associated with the need for PPI after TAVI with a self-expandable prosthesis (2)(3)(4)(5)(6)8,11), very few data exist on the prediction of such a complication after TAVI with a balloon-expandable valve. The occurrence of conduction disturbances and PPI is also a wellknown complication after surgical aortic valve replacement (SAVR), with an incidence ranging from 3.2% to 8.5% (17)(18)(19)(20)(21)(22)(23). However, most SAVR studies have included patients of very different ages and those undergoing coronary artery bypass grafting during the same intervention as well as those with both aortic stenosis (AS) and/or insufficiency as the predominant underlying aortic valve disease.…”

Impact of Permanent Pacemaker Implantation on Clinical Outcome Among Patients Undergoing Transcatheter Aortic Valve Implantation

“…Thus, PPM implantation has been reported in 3% to 9% (3)(4)(5)(6)(7)(8) of patients undergoing surgical aortic valve replacement, with lower rates in the past decade presumably resulting from improvements in surgical techniques (7,8).…”