New postoperative conduction abnormalities after the implantation of a rapid-deployment aortic valve prosthesis

Mogilansky, Christian; Balan, Robert; Deutsch, Cornelia; Czesla, Markus; Massoudy, Parwis

doi:10.1093/icvts/ivy307

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…Our study demonstrated that SURD-AVR and c-AVR were associated with similarly low incidences of PPM in patients with normal preoperative AV conduction (1.3% vs. 1.9%, P=0.6). Conversely, consistent with data reported by others (25,26), SURD-AVR emerged as risk factor for new onset LBBB. A possible explanation of this finding may be the radial force of the stented frame of SURD valve prostheses imposes pressure on the conduction system embedded in the interventricular septum within few millimeters from the aortic valve and compromises the left bundle branch.…”

Section: Discussionsupporting

confidence: 92%

Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?

Berretta¹,

Montecchiani²,

Vagnarelli³

et al. 2020

Ann Cardiothorac Surg

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Background: Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery. Methods: Data from 243 patients receiving minimally invasive AVR were prospectively collected. SURD-AVR was performed in 103 (42.4%) patients and c-AVR in 140 (57.6%). The primary endpoint was the occurrence of new-onset conduction disorders, defined as first degree atrioventricular (AV) block, advanced AV block requiring PPM implantation, left anterior fascicular block (LAFB), left bundle branch block (LBBB) and right bundle branch block (RBBB). Results: The unadjusted comparison revealed that SURD-AVR was associated with a higher rate of advanced AV block requiring PPM when compared with c-AVR (10.5% vs. 2.1%, P=0.01). After adjusting for other measured covariates (OR: 1.6, P=0.58) and for the estimated propensity of SURD-AVR (OR: 5.1, P=0.1), no significant relationship between type of AVR and PPM implantation emerged. On multivariable analysis, preoperative first-degree AV block (OR: 6.9, P=0.04) and RBBB (OR: 6.9, P=0.03) were independent risk factors for PPM. Subgroup analysis of patients with normal preoperative conduction revealed similar incidence of PPM between SURD-AVR and c-AVR (1.3% vs. 1.9%, P=0.6). When compared with c-AVR, SURD-AVR was associated with a greater incidence of postoperative new onset LBBB (18.1% vs. 3.2%, P<0.001). This finding was confirmed after adjusting for the estimated propensity of SURD-AVR (OR: 6.3, P=0.009). Conclusions: Our study revealed that the risk of PPM implantation in patients receiving surgical AVR is heavily influenced by the presence of pre-existing conduction disturbances rather than the type of valve prosthesis. Conversely, SURD-AVR emerged as an independent predictor for LBBB and was associated with an increased risk of PPM in patients presenting with RBBB.

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Section: Discussionsupporting

confidence: 92%

Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?

Berretta¹,

Montecchiani²,

Vagnarelli³

et al. 2020

Ann Cardiothorac Surg

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“…These incidences of PPM implantation are nevertheless lower than those found after a procedure by TAVR, which is estimated between 12% and 36% [ 7 , 8 ]. The underlying mechanism of these conductive disorders is probably related to direct trauma of the conduction pathways during the pneumatic expansion of the bioprosthesis with or without secondary inflammation [ 20 , 22 , 23 , 25 , 26 ]. In our study, the valve size was not associated with the pacemaker implantation, but conduction disturbances were most often observed immediately, arguing for a mechanical stress.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker implantation after aortic valve replacement: rapid-deployment Intuity® compared to conventional bioprostheses

Herry

Laghlam

Touboul

et al. 2020

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The aim of this study was to compare the incidence of permanent pacemaker (PPM) implantation after aortic valve replacement by rapid-deployment bioprosthesis (RDB) and standard valve (Standard). METHODS All patients undergoing aortic valve replacement between 2015 and 2018, in 1 centre, were included. A multivariate analysis on the whole cohort and then a propensity score matching were used to compare the 2 groups. The primary end point was PPM implantation. RESULTS We studied 924 patients (256 RDBs and 668 Standards). Overall, 67 PPM were implanted, 37 (14.5%) in the RDB group and 26 (3.9%) in the Standard group (P < 0.0001, univariate analysis). The multivariate analysis in the unmatched population found 4 independent factors associated with PPM implantation: right bundle branch block with odds ratios (ORs 3.7, 95% CI 2.9–6.7; P < 0.0001), RDB (OR 3.6, 95% CI 2.0–6.2; P < 0.0001), age (OR 1.1, 95% CI 1.0–1.1; P < 0.006) and endocarditis (OR 3.4, 95% CI 1.0–11.0; P < 0.04). In the propensity score-matched RDB group (203 patients per group), 25 patients required PPM implantation versus 3 in the Standard group (12.3% vs 1.5%, P < 0.0001). RDBs also had more postoperative left bundle branch block and new onset of atrial fibrillation (30.2% vs 5.1%, P < 0.0001 and 34.0% vs 24.1%, P = 0.029). RDBs had lower operating times (in min): aortic cross-clamping = 62 (44–76.5) vs 72 (57.5–91.5) and cardiopulmonary bypass = 81 (63–98.5) vs 91 (75–112), P < 0.0001. There was no significant difference in other outcomes. CONCLUSIONS RDBs were associated with reduced operating times, increased risk of atrial fibrillation and PPM implantation as compared with standard aortic valves.

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“…[40][41][42] The Intuity valve short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20% (Supporting Information: Table 7). 2,[43][44][45][46][47][48][49][50][51][52] Surgical indications included aortic valve stenosis and mixed valve pathology (Figure 1). (2) The Intuity valve evidence good long-term outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of PPI ranged between 4.1% and 8.45% (Supporting Information: Table ) 40–42 . The Intuity valve short‐term mortality ranged between 0.9% and 12.4% while long‐term mortality ranged between 2.6% and 20% (Supporting Information: Table ) 2,43–52 . Surgical indications included aortic valve stenosis and mixed valve pathology (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature

Dokollari

Torregrossa

Sicouri

et al. 2022

Journal of Cardiac Surgery

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Objectives To highlight short‐ and long‐term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. Methods We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta‐analysis, and gray literature. Results Fourty‐five clinical studies with 12.714 patients were included in the analysis. Thirty‐day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%−6.9% for SB. Long‐term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%−3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%−0.7% and Perceval 0%−1%), endocarditis (Intuity 0.2%−0.7% and Perceval 1.6%−6.6%), stroke (Intuity 0.36%−1.4% and Perceval 0%−0.8%), MI (Intuity 0.07%−0.26%), and SVD (Intuity 0.12%−0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%−2.1% for SFS. Hospital costs outcomes ranged from $37,187−$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short‐term mortality ranged between 0.9% and 12.4% while long‐term mortality ranged between 2.6% and 20%. Conclusions This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.

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New postoperative conduction abnormalities after the implantation of a rapid-deployment aortic valve prosthesis

Cited by 14 publications

References 18 publications

Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?

Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?

Pacemaker implantation after aortic valve replacement: rapid-deployment Intuity® compared to conventional bioprostheses

Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature

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