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

Abstract

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.

Rhythm disturbances following rapid-deployment aortic valve replacement

“…We found that sinus rhythm (SR) decreased in frequency over time (P <.001) and left bundle branch block (LBBB) increased in frequency over time (P ¼ .006). A study by Herry and colleagues 6 had similar findings from a single-center experience where they compared EIV with conventional aortic valve bioprosthesis. No significant changes in the frequencies of atrial fibrillation, first-degree heart block (HB), and right bundle branch block (RBBB) were noted over time.…”

Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta‐analysis

“…In our prespecified subgroup analysis, SuAVR did not significantly reduce mortality in high risk patients (OR: 0.16, 95% CI [0.02, 1.35], p = .09, Twenty studies (n = 26,812, SuAVR = 8635, SAVR = 18,177) reported stroke. [19][20][21][22][24][25][26]28,[41][42][43]46,67,[69][70][71][72][73][74][75] Stroke was similar between SuAVR and SAVR (OR: 1.04, 95% CI [0.82, 1.32], p = .77, I 2 = 6%, very-low quality). We did not detect publication bias on visual inspection.…”

“…49,53,54,62 Overall, 45 studies were at high risk, 34 studies were at unclear risk, and no studies were at low risk of bias. Appendix 2 includes risk of bias assessment of We pooled results from 26 studies [19][20][21][22][24][25][26][28][29][30][41][42][43][44]60,[65][66][67][68][69][70][71][72][73][74][75] (n = 27,614; SuAVR = 9028, SAVR = 18,586). The 30-day and 2-year mortality were similar between the two groups (30-day, OR: 0.99, 95% CI [0.85,1.16], p = .93, I 2 = 0%, very-low quality) and (2-year, OR: 0.99, 95% CI [0.43,2.30], p = .98, I 2 = 7%, very-low quality).…”

“…Twenty studies (n = 25,300, SuAVR = 8042, SAVR = 17,258) reported AXC time. 19,20,[22][23][24][25]28,30,40,41,43,44,46,68,[70][71][72][73][74][75] Cross-clamp time was lower with SuAVR (MD: 20.42 min, 95% CI [−27.72,−13.12], p < .00001, I 2 = 100%, very-low quality). We did not detect publication bias on visual inspection.…”

“…Seventeen studies ( n = 24,913, SuAVR = 7871, SAVR = 17,042) reported CPBs time 19,20,22,23,25,28,40,41,43,46,68,70–75 . CPB time was lower with SuAVR (MD: 18 min, 95% CI [−23.18,−12.82], p < .00001, I 2 = 99%, very‐low quality).…”