Surgery; Cardiology and Cardiovascular Medicine; aortic valve; pacemaker; cardiac surgery
Abstract :
[en] BACKGROUND: This study was conducted to determine the incidence of postoperative conduction disorders and need for pacemaker (PM) implantation after aortic valve replacement (AVR) with the Perceval prosthesis (Livanova, Saluggia, Italy).
METHODS: From January 2007 to December 2017, 908 patients underwent AVR with Perceval S in 5 participating centers. Study end points focused on electrocardiographic changes after AVR and the incidence of new PM implantation in 801 patients after exclusion of patients with previous PM (n = 48) or patients undergoing tricuspid (n = 28) and/or atrial fibrillation ablation (n = 31) surgery. Logistic regression analysis was performed to determine risk factors for PM need.
RESULTS: Mean age was 79.7 ± 5.2 years, and 476 (59.4%) were women. Median logistic European System for Cardiac Operative Risk Evaluation (2011 revision) score was 4.1% (interquartile range, 2.6%-6.0%). Isolated AVR was performed in 441 patients (55.1%). Associated procedures were coronary artery bypass grafting in 309 (38.6%) and mitral valve surgery in 51 (6.4%). Overall 30-day mortality was 3.9% and was 2.8% for isolated AVR. Electrocardiographic changes included a significant increase of left bundle branch block from 7.4% to 23.7% (P < .001) and development of complete atrioventricular block requiring PM implantation in 9.5%. Multivariable analysis revealed independent of a learning period (odds ratio [OR], 1.91; 95% confidence limits (CL), 1.16-3.13; P = .011), preexisting right-bundle branch block (OR, 2.77; 95% CL, 1.40-5.48; P = .003), intraoperative prosthesis repositioning (OR, 6.70; 95% CL, 1.89-24.40; P = .003), and size extra large (OR, 6.81; 95% CL, 1.55-29.96; P = .011) as significant predictors of PM implantation.
CONCLUSIONS: In a challenging elderly population, use of the Perceval S for AVR provides low operative mortality but at the risk of an increased PM implantation rate. Besides preexisting right bundle branch block, the significant effect of size extra large, an increased valve size/body surface area ratio, and need for intraoperative repositioning on PM rate are underscoring the reappraisal of the annular sizing policy.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Verlinden, Joke; Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium. Electronic address: joke.verlinden@ugent.be
Bové, Thierry; Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
de Kerchove, Laurent; University Hospital Université Catholique de Bruxelles St Luc-Brussels, Brussels, Belgium
Baert, Jerome; University Hospital Université Catholique de Bruxelles St Luc-Brussels, Brussels, Belgium
RADERMECKER, Marc ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
DURIEUX, Rodolphe ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
Van Kerrebroeck, Christian; Ziekenhuis Oost-Limburg, Genk, Belgium
SZECEL, Delphine ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique ; University Hospital Katholieke Universiteit Leuven Leuven, Leuven, Belgium
Meuris, Bart; University Hospital Katholieke Universiteit Leuven Leuven, Leuven, Belgium
Language :
English
Title :
Early Conduction Disorders After Aortic Valve Replacement With the Sutureless Perceval Prosthesis.
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