Early Predictors of Permanent Pacemaker Implantation in Sutureless Aortic Valve Replacement with Perceval Bioprosthesis: A Conduction Disorders Analysis

Context: The innovative Perceval bioprosthesis (Sorin Group S.p.A., Saluggia, Italy) is a surgical sutureless selfexpanding valve without a sewing ring. It has recently been introduced as an alternative to conventional surgery to minimize the operative risk in elderly patients. Advantages consist of both shortening the cardiopulmonary bypass time and enhancing the minimally invasive approach. Objective: Our study has the purpose to analyze the postoperative conduction disorders and identify the associated risk factors in patients undergoing a sutureless aortic valve replacement with the Perceval bioprosthesis. Methods: This is an observational study including 56 patients who underwent a sutureless aortic valve replacement. The conduction disorders were identified by reviewing the patients' electrocardiograms at baseline, postoperatively, before hospital discharge and at followup. Results: At baseline, five patients (8.9%) presented with pre-operative conduction disorders: two patients (3.6%) had left bundle branch block, one had right (1.8%), one right and left anterior hemiblock, while another showed a Mobitz 1 second-degree atrio-ventricular block. No one had a pre-existing permanent pacemaker. Six patients (10.7%) needed a pacemaker implantation: one for junctional rhythm with an underling atrial fibrillation, one for second-degree and four for third-degree atrioventricular block respectively. Among the 6 patients who implanted a pacemaker, four patients had preoperative conduction disorders (p<0.001) and one patient had anatomical risk factors (small aortic annulus and an offlabel concomitant mitral valve replacement). Conclusions: The presence of preoperative conduction disorders is a statistically significant risk factor for permanent pacemaker implantation following a sutureless aortic valve replacement with the Perceval bioprosthesis.

Author(s): Belluschi Igor, Moriggia Stefano, Calabrese Mariachiara, Schiavi Davide and Alfieri Ottavio

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