Recovery of conduction disorders after sutureless aortic valve replacement.

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomaterials Science

Background:

• Conduction disorders and permanent pacemaker (PPM) implantation are known risks following surgical aortic valve replacement (SAVR).
• The long-term resolution of conduction disturbances and pacemaker dependency after sutureless aortic valve implantation remains unclear.
• The Perceval sutureless valve is increasingly used, necessitating an understanding of its impact on cardiac conduction.

Purpose of the Study:

• To evaluate the recovery of conduction disorders after Perceval sutureless valve implantation.
• To assess the persistence of left bundle branch blocks (LBBBs) and pacemaker dependency during follow-up.
• To determine if conduction disturbances following this specific sutureless valve procedure resolve over time.

Main Methods:

• Retrospective analysis of 184 patients who underwent isolated SAVR or SAVR with coronary artery bypass grafting using the Perceval valve (2010-2018).
• Postoperative electrocardiograms (ECGs) were analyzed for new-onset LBBB and PPM requirement.
• ECGs during 6-18 month follow-up assessed LBBB persistence and PPM dependency.

Main Results:

• 39 patients (21.2%) developed new-onset LBBB; 10 patients (5.4%) required PPM postoperatively.
• Conduction disorder incidence was not linked to valve size.
• Of those with new LBBB, 35.9% recovered. 70% of PPM-dependent patients remained dependent.

Conclusions:

• New-onset LBBB after Perceval aortic valve implantation shows recovery in over a third of patients.
• The majority of patients requiring a PPM after Perceval valve implantation remain pacemaker dependent.
• These findings highlight the potential for conduction recovery but also the persistent need for pacing in a significant subset.