Need for Permanent Pacemaker Implantation following Aortic Valve Replacement with Rapid Deployment Aortic Valve in Combined Procedures

Objectives: Rapid deployment aortic valves may interfere with the cardiac conduction system. We investigated the need for permanent pacemaker implantation (PPI) following aortic valve replacement (AVR) using a rapid deployment aortic valve.

Methods: A total of 120 patients underwent AVR with rapid deployment aortic valves in combined procedures at the German Heart Centre Munich between April 2016 and December 2019. Twenty-four patients with prior PPI or concomitant ablation procedures (24/120, 20%) were excluded. Patient-specific, procedural and post-procedural outcomes were assessed in the remaining 96 cases.

Result: AVR was successful in all cases. 74% of the study population was men. Mean age was 69.5 ± 7.6 years. EuroSCORE II was 3.2 ± 2.9. 46 patients (46/96, 47.9%) presented with preoperative conduction disorders, right bundle branch block (RBBB) (17/96, 17.7%) and first-degree or second-degree atrioventricular block (AVB) (18/96, 18.8%), in particular. In total, nine patients (9/96, 9.4%) underwent PPI. PPI was required in 3 patients (3/50, 6.0%) who did not have a preexisiting conduction disorder due to new high degree AVB. Six patients with pre-operative conduction disorders (6/46, 13%) needed PPI. Timing of PPI was 5.2 ± 1.5 days (median 5). Independent predictors of PPI were preoperative RBBB (odds ratio = 4.554, p = 0.049) and large valve size (#27) (OR = 5.527, p = 0.031).

Conclusion: The analysis of the data collected enabled us to identify patient factors associated with higher risk for postoperative PPI following AVR with a rapid deployment aortic valve. Patient factors associated with post-operative PPI, were RBBB and large valve size. These patients should be closely monitored following the procedure, in particular.

Publication History

Article published online:
19 February 2021