Sutureless Aortic Valve Replacement: How to Reduce the Risk of Postoperative Conduction Disorders and Pacemaker Implants

Objective: Sutureless bioprosthesis are associated with an increased risk of postoperative conduction disorders.

Methods: We analyzed 433 patients who underwent AVR with a self-expandable sutureless bioprosthesis from July 2010 to September 2016 at our Centre. Since September 2015 technical modifications to lower the rate of pacemaker implantation in patients undergoing these bioprosthesis are introduced. In short, attention to the appropriate depth of guiding suture placement, attention to the angle of the holder during deployment with regards to the seating of the valve and a lower balloon-plasty pressure of 2 atm. We compared the patients operated before September 2015 (BEFORE-Group) and the following patients (AFTER-Group).

Results: Excluding the patients with an implanted pacemaker (15 patients), postoperatively, 45 patients (10.8%) required new pacemaker implantation due to complete atrioventricular block. 328 patients are in the BEFORE-group and received 40 pacemakers (12.2%) and for the 90 AFTER-group patients, 5 received a Pacemaker (5.5%) (p = 0.048). Between groups there were differences in terms of general risks (log EuroSCORE 12 ± 10 BEFORE vs 9.5 ± 7 AFTER, p = 0.01) but no difference in special known risks for postoperative pacemaker implantation such as age (Mean age: 77 ± 5 years old BEFORE vs 76 ± 5 AFTER, p = 0.28) and right bundle branch block (RBBB BEFORE 20 patients, 8.4% vs AFTER 8 patients 8.9%, p = 0.52).

Conclusion: The analysis of the collected data demonstrates that additional surgical precautions are able to reduce conduction disorders. Therefore, these considerations should be respected to prevent permanent pacemaker implantation.

No conflict of interest has been declared by the author(s).