Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement

Atrioventricular (AV) conduction impairment represents an infrequent complication following aortic valve replacement (AVR). Although several conditions have been considered as potential risk factors for such a postoperative event, the role of the surgical technique has not been evaluated. The aim of this study was to investigate if the suture technique for implantation of the prosthetic valve is a potential risk factor need of pacemaker (PM) implantation after AVR.

One hundred twenty-four patients undergoing AVR were enrolled in this study. A "continuous" suture technique was performed in 72 patients (58%; Group A), whereas an "interrupted" suture technique was used in 52 patients (42%; Group B). The incidence of "major," requiring PM implantation, as well as "minor," without PM implantation, impairment of the AV conduction was evaluated and compared in the two groups by means of univariate and multivariate analyses.

The patients of the two groups were homogenous for all preoperative parameters except patient age. A longer clamp time was present in the patients of group B than those of group A (73 +/- 24 minutes and 60 +/- 24 minutes, respectively; p < 0.01). Postoperatively, hospital mortality consisted of four patients (3.2%) with no statistical importance between the two groups. Eleven patients of group A (17.5%) and one patient of group B1 (2.2%) required PM implantation (p < 0.05). Prolonged P-R interval was recorded in 15 patients of group A and in 5 patients of group B (p < 0.05).

We showed that the continuous suture technique increases the need for postoperative PM implantation after AVR. No major differences have been observed, however, regarding in-hospital mortality and length of hospital stay, regardless of the type of prosthetic suture technique.