Early Conduction Disorders After Aortic Valve Replacement With the Sutureless Perceval Prosthesis

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Clinical Outcomes

Background:

• Aortic valve replacement (AVR) is a critical procedure for managing aortic valve disease.
• The Perceval S prosthesis is a transcatheter heart valve used in AVR.
• Postoperative conduction disorders and pacemaker (PM) implantation are potential complications following AVR.

Purpose of the Study:

• To determine the incidence of postoperative conduction disorders after AVR using the Perceval prosthesis.
• To assess the need for pacemaker implantation following Perceval S prosthesis implantation.
• To identify risk factors associated with pacemaker implantation after AVR.

Main Methods:

• A retrospective study of 908 patients undergoing AVR with the Perceval S prosthesis from 2007 to 2017.
• Analysis focused on 801 patients, excluding those with prior pacemakers or concurrent tricuspid/atrial fibrillation ablation.
• Logistic regression analysis was used to identify predictors of PM implantation.

Main Results:

• The study included 801 patients with a mean age of 79.7 years; 59.4% were women.
• A significant increase in left bundle branch block (7.4% to 23.7%) and a 9.5% rate of complete atrioventricular block requiring PM implantation were observed.
• Independent predictors for PM implantation included a learning period, preexisting right bundle branch block, intraoperative prosthesis repositioning, and extra-large prosthesis size.

Conclusions:

• The Perceval S prosthesis for AVR in elderly patients offers low operative mortality but is associated with an increased rate of pacemaker implantation.
• Preexisting right bundle branch block, larger prosthesis size (extra-large), increased valve size/body surface area ratio, and intraoperative repositioning are significant predictors of PM need.
• These findings highlight the need to reappraise annular sizing policies for the Perceval S prosthesis.