Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations

Abstract

Background: Permanent pacemaker (PPM) implantation and paravalvular leak (PVL) rates after sutureless aortic valve replacement (SuAVR) vary widely. The aim of this metaanalysis was to examine the incidence of new PPM implantation and PVL after SuAVR.Methods: Studies evaluating PPM implantation and PVL rates after SuAVR were searched in Medline/PubMed, Ovid Journals, Clinicaltrials.gov, Cochrane central register of controlled trials and database. Studies with a sample size ≥10 were included in this analysis. Pooled proportions were calculated using both the fixed and randomeffects models. The heterogeneity among studies was tested using I 2 statistic. The study design was written in accordance with PRISMA guidelines.Results: Thirty studies involving 3993 patients with a median follow-up of 12 months were included. The median age was 77 years and males constituted 50%. There was a history of stroke and coronary artery disease in 6% and 31% of the population. Pooled proportions demonstrate a cumulative postoperative PPM rate of 8.5% (95% confidence interval [CI] 7.6-9.5%, I 2 = 68.8%) and the overall rate of any PVL was 4.2% (95%CI 3.4-5%, I 2 = 76.1%) across all major SuAVR devices. The rate of severe PVL was only 0.4% (95%CI 0.2-0.7%, I 2 = 0%) at discharge and 0.5% (95%CI 0.2-0.9%, I 2 = 0%) at 12 months. Conclusions:In SuAVR prostheses implanted in this meta-analysis, the postoperative permanent pacemaker rate was higher (8.5%) than reported for non-SuAVR prosthesis.While the overall PVL rate was 4.2%, the incidence of severe PVL was only 0.4% at discharge and remained stable at 0.5% at 12 months. K E Y W O R D S paravalvular leak, permanent pacemaker, rapid deployment aortic valve, sutureless aortic valve

Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis

“…The PPM insertion rates from this current study are also much lower than those reported for TAVR (13.2%) and acceptable when compared to the 3.0% reported for conventional AVR in the meta-analysis by Cao et al (35). A recent meta-analysis (36) reported PVL incidence of 4.2% at 30-day and 5.9% at 1-year follow-up after TAVR. In the same study, incidence rates of severe PVL were 0.4% (30-day) and 0.5% (1-year follow-up).…”

The sutureless and rapid-deployment aortic valve replacement international registry: lessons learned from more than 4,500 patients

“…Concern exists regarding the increased incidence of conduction abnormalities following SURD-AVR (36,(47)(48)(49)).…”

Invited Commentary

“…Currently available sutureless prostheses have excellent hemodynamic performance and have been shown to reduce cross-clamp times but increase the risk of permanent pacemaker implantation (PPI) [1,2]. Although the risk of PPI is generally less than 5% with standard techniques, a recent meta-analysis documents a more than 2-fold increased risk of early PPI associated with sutureless valves [3]. This is of considerable concern because the presence of conduction abnormalities following percutaneous valve implantation increases the risk of late mortality [4].…”