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Related Experiment Video

Updated: Dec 13, 2025

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Modified annular suturing technique for minimizing postoperative pacemaker use after surgical aortic valve

Hiromi Yanagisawa1, Minoru Tabata2

  • 1Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-shi, Chiba, Japan.

General Thoracic and Cardiovascular Surgery
|July 30, 2020
PubMed
Summary

A novel suturing technique significantly reduced the need for temporary pacing after surgical aortic valve replacement. This modified approach may further improve surgical aortic valve replacement outcomes compared to transcatheter procedures.

Keywords:
PacemakerSurgical aortic valve replacementSuturing technique

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Electrophysiology
  • Medical Device Innovation

Background:

  • Surgical aortic valve replacement (SAVR) offers advantages over transcatheter aortic valve replacement (TAVR), including a lower rate of permanent pacemaker implantation.
  • However, conduction disturbances and the need for temporary pacing remain areas for improvement in SAVR.
  • A novel suturing technique was developed to minimize proximity to the heart's conduction system during SAVR.

Purpose of the Study:

  • To assess the effectiveness and safety of a new modified suturing technique in reducing conduction disturbances after SAVR.
  • To compare the incidence of new-onset heart blocks and temporary pacemaker use between the modified and standard suturing techniques.
  • To evaluate the impact of the technique on permanent pacemaker implantation rates within 30 days post-surgery.

Main Methods:

  • A retrospective review of 257 patients undergoing SAVR between October 2013 and August 2019.
  • Patients were divided into two groups: 83 who received the modified suturing technique (Group A) and 174 who underwent standard techniques (Group B).
  • Conduction disturbances, temporary pacing, and permanent pacemaker implantation rates were compared between groups, including a subgroup analysis of isolated SAVR cases.

Main Results:

  • The modified technique group (Group A) showed a 0% incidence of new left bundle branch block and new 2nd/3rd-degree atrioventricular block, compared to 6.6% and 5.2% in the standard group (Group B), respectively (p<0.05).
  • Postoperative temporary pacing use was significantly lower in Group A (2.4%) versus Group B (12.6%) (p<0.01).
  • No significant difference in 30-day permanent pacemaker implantation was observed (0% in Group A vs. 1.1% in Group B, p=1.00).

Conclusions:

  • The modified suturing technique effectively reduced postoperative temporary pacemaker use following SAVR.
  • This technique may enhance the comparative advantage of SAVR over TAVR by further minimizing procedural complications.
  • The findings support the adoption of this modified suturing approach to improve SAVR patient outcomes.