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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
Summary
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.
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.
