Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement

Toledano, Beatriz; Bisbal, Felipe; Cámara, María Luisa de la; Labata, Carlos; Berastegui, Elisabet; Gálvez‐Montón, Carolina; Villuendas, Roger; Sarrias, Axel; Oliveres, Teresa; Pereferrer, Damià; Ruyra, Xavier; Bayés‐Genís, Antoni

doi:10.1093/icvts/ivw259

Cited by 30 publications

(15 citation statements)

References 23 publications

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“…The modification in surgical technique involved a more thorough, symmetrical decalcification and higher positioning guiding sutures to the intra-annular level. 53 Overall incidence of permanent pacemaker implantation was 12%, whereas incidence in each of the standard technique and modified technique were 21% and 8%, respectively. 53 Independent predictors of permanent pacemaker implantation were baseline first-degree atrioventricular block (P < 0.01), left QRS axis deviation (P = 0.03), and standard surgical technique (P = 0.02).…”

Section: Permanent Pacemaker Implantationmentioning

confidence: 92%

“…53 Overall incidence of permanent pacemaker implantation was 12%, whereas incidence in each of the standard technique and modified technique were 21% and 8%, respectively. 53 Independent predictors of permanent pacemaker implantation were baseline first-degree atrioventricular block (P < 0.01), left QRS axis deviation (P = 0.03), and standard surgical technique (P = 0.02). 53 Yanagawa et al 54 examined the effect of a modification in operative technique on permanent pacemaker implantation.…”

Section: Permanent Pacemaker Implantationmentioning

confidence: 92%

“…Five studies investigated the predicting factors for permanent pacemaker implantation after SAVR with the Perceval, two of which examined the effect of modifying surgical technique on permanent pacemaker implantation. [50][51][52][53][54] Vogt et al 50 examined the predictors of permanent pacemaker implantation in 258 patients who had undergone SAVR using the Perceval, 27 (10%) of which underwent postoperative permanent pacemaker implantation. Age and the presence of preoperative right bundle branch block (RBBB) were determined to be significantly different between the groups on univariate analysis (80 ± 5 vs 77 ± 5 years, P = 0.009, and 33% vs 4.8%, P < 0.001), whereas only preoperative RBBB was significantly different on multivariate analysis (OR = 11.3, P = 0.0002).…”

Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

“…52 Independent predictors of new-onset conductive disorder or permanent pacemaker implantation were preoperative RBBB (P = 0.03), small preoperative EOA (P = 0.02), and age younger than 85 years (P = 0.03). 52 Toledano et al 53 investigated the predictors of permanent pacemaker implantation and effect of modifying surgical technique in 140 patients. The modification in surgical technique involved a more thorough, symmetrical decalcification and higher positioning guiding sutures to the intra-annular level.…”

Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

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The Perceval Sutureless Aortic Valve

Powell

Pelletier

Chu

et al. 2017

Innovations�(Phila)

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Surgical aortic valve replacement with a stented prosthesis has been the standard of care procedure for aortic stenosis. The Perceval (LivaNova, London, United Kingdom) is a sutureless aortic valve bioprosthesis currently implanted in more than 20,000 patients. The purpose of this article was to review the literature available after 9 years of clinical experience of the Perceval aortic valve. PubMED, Embase, and the Cochrane Library databases were searched. A meta-analysis of summary statistics from individual studies was conducted. A total of 333 studies were identified and 84 studies were included. Thirty-day mortality and 5-year survival ranged from 0% to 4.9% and 71.3% to 85.5%, respectively. Compared with stented prosthesis, pooled analysis demonstrated a statistically significant reduction in aortic cross-clamp and cardiopulmonary bypass times (minutes) with Perceval (38.6 vs 63.3 and 61.4 vs 84.9, P < 0.00001, respectively). Compared with transcatheter aortic valve implantation, pooled analysis demonstrated a statistically significant reduction with Perceval in paravalvular leakage (1.26% vs 14.31%) and early mortality (2.3% vs 6.9%). Favorable hemodynamics, acceptable valve durability, and ease of implantation in minimally invasive cases were reported as benefits. A trend toward increased rates of permanent pacemaker implantation and low postoperative platelet count were identified. Special use and off-label procedures described included bicuspid aortic valves, valve-in-valve for homo-graft and stentless prosthesis failure, concomitant valvular procedures, porcelain aorta, and endocarditis. The Perceval valve has shown safe clinical and hemodynamic outcomes. Outcomes support its continued usage and potential expansion.

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Section: Permanent Pacemaker Implantationmentioning

confidence: 92%

Section: Permanent Pacemaker Implantationmentioning

confidence: 92%

Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

Section: Permanent Pacemaker Implantationmentioning

confidence: 99%

See 2 more Smart Citations

The Perceval Sutureless Aortic Valve

Powell

Pelletier

Chu

et al. 2017

Innovations�(Phila)

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“…2. ECG: Pre-operative conduction disorders are an independent risk factor for permanent pacemaker insertion [26]. Use of rapid deployment or suture less bio prosthesis increases the risk of complete atrioventricular block.…”

Section: Pre-operative Investigationsmentioning

confidence: 99%

Minimally Invasive Right Anterior Mini-Thoracotomy Aortic Valve Replacement

Khan¹,

Smith²,

Trehan³

2020

Cardiac Surgery Procedures

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Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post-operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid backup plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement.

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Perceval sutureless valve migration treated by valve‐in‐valve with a CoreValve Evolut Pro

Laricchia

Mangieri

Colombo

et al. 2019

Cathet Cardio Intervent

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In the last years, the use of sutureless devices in frail patients with severe aortic stenosis has increased thanks to their “easier and faster” technique of implantation in comparison to conventional surgery. Results from metanalysis show comparable outcomes in comparison to transcatheter aortic valve replacement (TAVR) in terms of mortality, stroke incidence, and rate of pace‐maker implantation. The incidence of para‐valvular leak (PVL) is even lower for sutureless devices than for TAVR. The few cases described are generally due to incomplete decalcification or incorrect valve sizing and consequent stent distortion. To our knowledge this is the first case describing PVL with massive aortic regurgitation due to early partial embolization of a Perceval valve and its successfully treatment with valve‐in‐valve by using a self‐expanding TAVR device.

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Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement

Abstract: NO-AVB is a frequent complication following SU-AVR, and its incidence strongly depends on the surgical technique. Baseline first-degree AVB and LaQD independently predict NO-AVB and should be considered when deciding the duration of postoperative electrocardiographic monitoring.

Cited by 30 publications

References 23 publications

The Perceval Sutureless Aortic Valve

The Perceval Sutureless Aortic Valve

Minimally Invasive Right Anterior Mini-Thoracotomy Aortic Valve Replacement

Perceval sutureless valve migration treated by valve‐in‐valve with a CoreValve Evolut Pro

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