Pacemaker implantation after sutureless or stented valve: results from a controlled randomized trial.

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomaterials Science

Background:

• Sutureless aortic valves (Su-AVR) offer a less invasive alternative to traditional stented valves for aortic valve replacement.
• While demonstrating non-inferiority in major cardiovascular and cerebral events, the incidence of permanent pacemaker implantation (PPI) requires further investigation.

Purpose of the Study:

• To identify factors associated with permanent pacemaker implantation (PPI) after aortic valve replacement using either sutureless aortic valves (Su-AVR) or stented valves (SAVR).
• To compare the rates and predictors of PPI between Su-AVR and SAVR cohorts.

Main Methods:

• Prospective, randomized, open-label trial (PERSIST-AVR) comparing Su-AVR and SAVR.
• Multivariable and logistic regression analyses were performed to identify independent risk factors for PPI.
• Patients were assessed for preoperative risk factors and valve size correlation with PPI.

Main Results:

• The Su-AVR group (n=450) showed a higher early PPI rate (10.4%) compared to the SAVR group (n=446, 3.1%).
• In the Su-AVR cohort, PPI correlated with XL valve size (P=0.0119) and preoperative conduction disturbances (P=0.0079).
• Logistic regression indicated a significantly higher risk of PPI with XL sutureless valves compared to smaller sizes, but no predictors were found in the SAVR group.

Conclusions:

• Sutureless aortic valve replacement is associated with a higher PPI rate than stented valves, primarily driven by XL valve size.
• The combination of preoperative conduction disorders and XL valve size represents a significant risk factor for early PPI in Su-AVR.
• Careful patient selection and consideration of valve size are crucial for mitigating PPI risk in Su-AVR procedures.