Predictors of Pacemaker Insertion Post-Sutureless (Perceval) Aortic Valve Implantation

Brookes, John; Mathew, Manish; Brookes, Elizabeth; Jaya, Joseph; Almeida, Aubrey; Smith, Julian A.

doi:10.1016/j.hlc.2020.11.004

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…[40][41][42][43] Surgical implantation technique may also contribute to atrioventricular conduction disorders. 41,[44][45][46] Accurate annulus decalcification, positioning of guide suture, minimizing the traction on the valve commissures, and the balloon pressure may reduce the rate of pacemaker implantation after sutureless AVR. 44,47) Though the present meta-analysis indicated that the rate of pacemaker implantation was higher following Perceval implantation, at study level, high heterogeneity can be evidenced.…”

Section: Discussionmentioning

confidence: 99%

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis

Colarossi

Migliorini

Becker

et al. 2023

ATCS

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Purpose: Perceval sutureless valves have gained popularity. Whether this implant performs superior to the traditional sutured prosthesis remains unclear. This metaanalysis compared the Perceval implants versus the sutured conventional valves for aortic valve replacement (AVR). Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were accessed: PubMed, Google Scholar, Web of Science, Scopus, and EMBASE. All clinical investigations comparing Perceval versus the conventional prostheses for AVR were considered. Results: The Perceval group demonstrated higher rate of pacemaker implantation (P <0.00001). Aortic cross-clamp (ACC) time (P <0.00001) and cardiopulmonary bypass (CPB) time (P <0.00001) were shorter in the Perceval group. Similarity was found in mean and peak pressure gradient (P = 0.8 and P = 0.2, respectively), mean aortic valve area (P = 0.3), length of intensive care unit (P = 0.4) and hospital stay (P = 0.2), rate of revision (P = 0.11), hemorrhages (P = 0.05), paravalvular leak (P = 0.3), cerebrovascular complication (P = 0.7), and early mortality (P = 0.06). Conclusion: Given the shorter ACC time and CPB time, Perceval AVR can be an alternative in high-risk patients. The higher rate of pacemaker implantation following Perceval may limit its routine implantation.

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Section: Discussionmentioning

confidence: 99%

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis

Colarossi

Migliorini

Becker

et al. 2023

ATCS

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“…The presence of pre-existing atrio- or intraventricular conduction anomalies also deserves particular attention. We found no association between these 2 types of conduction anomalies and the rate of pacemakers inserted postoperatively (data not shown), but Brookes and colleagues [ 21 ] suggested that preoperative right bundle branch block, prolonged QRS complex and longer PR intervals are associated with an increased risk of the need to insert a pacemaker postoperatively. Therefore, the presence of conduction abnormalities preoperatively should be evaluated when one is contemplating implanting a Perceval valve in these patients.…”

Section: Discussionmentioning

confidence: 53%

Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant

Fabre

Radutoiu

Carjaliu

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives To compare pacemaker rate usage following two different operating Perceval implantation techniques for aortic valve replacement. Methods In this retrospective single-center study, we studied cases of isolated or concomitant Perceval aortic valve replacement, operated first between April 2013 and January 2016, following traditional operating techniques with cases operated between January 2016 and December 2020, after the adoption of a modified protocol based in different annulus sizing, higher positioning of the valve and no ballooning after valve deployment was adopted. Surgery was performed by two surgeons and patients were followed-up for a period of 30 days. Results A total of 286 patients, with a mean age of 77 (4.9) years underwent Perceval valve implantation during the study period, of which 79% with isolated aortic valve surgery. Most patients (66.8%) underwent minimally invasive procedures. Cross-clamp time was of 55.1 (17.6) min. The overall postoperative pacemaker rate was of 8.4% which firmly decreased after the 2016 change of the implantation protocol (16% vs 5.6%, p = 0.005), adjusted OR of 0.31 (95% CI: 0.13–0.74, p 0.012). Univariable and multivariable analysis showed that larger valve size (p = 0.01) and ballooning (p = 0.002) were associated with higher risk of pacemaker implantation. Postoperative 30-day mortality was of 4.5%. Conclusions Improvement of operating techniques in Perceval valve implantation may decrease postoperative pacemaker rate. Although further studies are needed to confirm these results, such a risk reduction may lead to wider use of Perceval valve implantation in the future, potentially benefiting patients who are suitable candidates for minimally invasive surgery.

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“…9,10 However, our ability to identify patients who are at high-risk of requiring PPI pre-operatively remains unfortunately sparse 12 and mainly linked to single-centers studies. 9,10,[12][13][14] Therefore, the purpose of this study was to use a large national database to determine the contemporary incidence of early postoperative PPI in patients undergoing isolated SAVR through a multicenter investigation and to identify patient's criteria and procedural risk factors for PPI after SAVR in a nationwide registry.…”

Section: Introductionmentioning

confidence: 99%

“…9 , 10 However, our ability to identify patients who are at high‐risk of requiring PPI pre‐operatively remains unfortunately sparse 12 and mainly linked to single‐centers studies. 9 , 10 , 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

“…Other factors, like reoperations, longer cross‐clamping times, absence of preoperative sinus rhythm, preoperative concomitant aortic regurgitation and, pre‐existing conduction disorders, have also been found to be predictors of PPI post SAVR 9,10 . However, our ability to identify patients who are at high‐risk of requiring PPI pre‐operatively remains unfortunately sparse 12 and mainly linked to single‐centers studies 9,10,12–14 …”

Section: Introductionmentioning

confidence: 99%

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Incidence and predictors of permanent pacemaker implantation after surgical aortic v alve replacement: Data of the Netherlands Heart Registration (NHR)

Ravaux

Kuijk

Mauro

et al. 2021

Journal of Cardiac Surgery

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Objective: Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. Materials and Methods: Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR.Results: From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% con-

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Predictors of Pacemaker Insertion Post-Sutureless (Perceval) Aortic Valve Implantation

Cited by 7 publications

References 18 publications

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis

Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant

Incidence and predictors of permanent pacemaker implantation after surgical aortic v alve replacement: Data of the Netherlands Heart Registration (NHR)

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