Risk Factors for Postoperative Pacemaker Implantation After Rapid Deployment Aortic Valve Replacement: Results from...

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Devices

Background:

• Rapid deployment aortic valve replacement (RD-AVR) offers reduced surgical times and good short-term hemodynamic outcomes.
• However, an increased requirement for permanent pacemaker (PPM) implantation post-RD-AVR has been noted, with unclear risk factors.

Purpose of the Study:

• To evaluate early outcomes of RD-AVR using the Edwards INTUITY Elite valve within the RADAR Registry.
• Specifically, to identify risk factors associated with postoperative complete or high-grade atrioventricular block (AV block) requiring PPM implantation.

Main Methods:

• A prospective registry study (RADAR) included 164 patients undergoing RD-AVR between April 2012 and January 2016.
• Data collected included pre-, intra-, and postoperative clinical details, complications, and 1-year follow-up for clinical and echocardiographic outcomes.
• Focus was placed on identifying risk factors for AV block necessitating PPM implantation.

Main Results:

• 164 patients were analyzed; 128 (78.05%) had isolated AVR, 36 (21.95%) had combined procedures.
• Postoperative complete or high-grade AV block requiring PPM occurred in 10 patients (6.9%).
• Multivariate analysis identified low patient weight and preoperative arrhythmias (atrial fibrillation, bifascicular block, left bundle branch block) as significant risk factors for AV block requiring PPM.

Conclusions:

• Early experience with RD-AVR in the RADAR Registry shows low implantation complications and favorable perioperative and 1-year outcomes.
• The incidence of postoperative AV block requiring PPM is linked to low weight and specific preoperative arrhythmias.
• Minimizing PPM risk may involve avoiding oversizing the prosthesis and careful patient selection for those with pre-existing arrhythmias.