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

Area of Science:

• Cardiovascular Surgery
• Bioprosthetic Valves
• Cardiac Electrophysiology

Background:

• Aortic valve replacement (AVR) is a common procedure to treat aortic valve disease.
• Rapid-deployment bioprosthetic valves (RDBs) offer potential advantages in surgical time.
• The impact of RDBs on permanent pacemaker (PPM) implantation requires further investigation.

Purpose of the Study:

• To compare the incidence of PPM implantation following AVR using RDBs versus standard valves.
• To identify factors associated with PPM implantation after AVR.

Main Methods:

• Retrospective analysis of 924 patients undergoing AVR between 2015 and 2018.
• Multivariate analysis and propensity score matching were employed to compare RDB and standard valve groups.
• The primary endpoint was PPM implantation.

Main Results:

• RDBs were associated with a significantly higher rate of PPM implantation (14.5% vs 3.9%, P < 0.0001).
• Propensity score matching confirmed this increased risk (12.3% vs 1.5%, P < 0.0001).
• RDBs also showed increased rates of new-onset atrial fibrillation and left bundle branch block, but reduced operating times.

Conclusions:

• RDBs are associated with reduced operating times but an increased risk of PPM implantation and atrial fibrillation compared to standard aortic valves.
• The findings highlight a trade-off between surgical efficiency and potential complications with RDBs.