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Related Experiment Video

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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Predictors of Pacemaker Insertion Post-Sutureless (Perceval) Aortic Valve Implantation.

John D L Brookes1, Manish Mathew1, Elizabeth M Brookes1

  • 1Department of Cardiothoracic Surgery Monash Health, Melbourne, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia.

Heart, Lung & Circulation
|December 14, 2020
PubMed
Summary
This summary is machine-generated.

Sutureless aortic valve replacement (AVR) with the Perceval S valve increases the risk of permanent pacemaker (PPM) implantation. Pre-existing right bundle branch block, longer QRS duration, and longer PR intervals are key predictors for PPM need post-AVR.

Keywords:
Aortic stenosisElectrocardiographyPacemakerSutureless aortic valve replacement

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Sutureless aortic valve replacement (AVR) offers a rapid alternative to conventional AVR, particularly for high-risk patients.
  • However, sutureless AVR is linked to higher rates of permanent pacemaker (PPM) implantation compared to traditional methods.
  • Identifying predictors for PPM insertion after sutureless AVR is crucial for patient management.

Purpose of the Study:

  • To identify factors predicting the need for permanent pacemaker (PPM) insertion after Perceval S sutureless aortic valve replacement (AVR).
  • To aid in patient selection, counseling, and postoperative management for sutureless AVR procedures.

Main Methods:

  • A retrospective cohort study analyzed 130 patients who underwent Perceval S sutureless AVR between July 2015 and September 2019.
  • Data collected included demographics, preoperative ECG, and operative details.
  • Postoperative PPM implantation and electrophysiology clinic follow-up were reviewed.

Main Results:

  • 14.6% (19/130) of patients required PPM insertion post-sutureless AVR.
  • Predictive factors for PPM insertion included pre-existing right bundle branch block (42.1% vs. 6.31%, p<0.01).
  • Longer QRS duration (113.32ms±22.24ms vs. 100.52±20.96ms, p=0.017) and PR interval (185.166±42.38ms vs. 169.23±25.70ms, p=0.03) were also associated with increased PPM need.

Conclusions:

  • Preoperative right bundle branch block, prolonged QRS duration, and longer PR intervals are significant risk factors for requiring a PPM after Perceval S sutureless AVR.
  • These electrophysiological parameters should be considered during patient evaluation and management for sutureless AVR.
  • Improved patient selection and counseling based on these predictors can optimize outcomes for sutureless AVR.