Postoperative conduction disorders after implantation of the self-expandable sutureless Perceval S bioprosthesis

Minimally invasive techniques for aortic valve replacement (AVR) have been developed as an alternative to conventional AVR for patients with high operative risk. Yet, these techniques are still associated with an increased risk of postoperative conduction disorders. The study aim was to identify the incidence and fate of postoperative conduction disorders in patients undergoing sutureless (SU) AVR with the Perceval S bioprosthesis.

In this observational study, patients who underwent SU AVR with the Perceval S prosthesis at the Catharina Hospital, Eindhoven, were analyzed. Electrocardiograms (ECGs) recorded at baseline, within 24 h postoperatively, before hospital discharge and at follow up were collected by reviewing patients' records. The ECGs were analyzed by two independent investigators to record QRS-duration and conduction disorders.

All patients (n = 31) who underwent implantation of the Perceval S bioprosthesis between September 2010 and September 2012 were included. At baseline, three patients (9.7%) had preexisting left bundle branch block (LBBB), and one patient (3.2%) had a permanent pacemaker (PPM). New-onset LBBB developed in 11 patients (39.3%), and was transient in three patients (10.7%). Postoperatively, four patients (13.3%) required PPM implantation because of total atrioventricular block; all of these patients had either pre-existing LBBB (n = 1) or new LBBB (n = 3).

Sutureless AVR with the Perceval S bioprosthesis was frequently complicated by new LBBB, which was persistent in the majority of patients. A relatively high incidence of postoperative PPM implantation was also observed.