Long-Term Pacemaker Dependency after Rapid Deployment Aortic Valve Replacement

Background: The incidence of new permanent pacemaker implantation (PPI) after rapid deployment aortic valve replacement (RDAVR) is controversially discussed. Besides a learning curve, different operative strategies are debated to reduce the relatively high risk for PPI after RDAVR. Aim of our study was to investigate the long-term pacemaker dependency of patients with PPI after RDAVR.

Method: Long-term follow-up of 372 consecutive patients who underwent RDAVR with either Edwards INTUITY Elite or LivaNova Perceval valve between May 2012 and August 2018 was performed. The observation period of up to 9 years was analyzed with respect to long-term pacemaker dependency after new PPI following RDAVR. All patients were analyzed with respect to relevant perioperative data including hemodynamic parameter, postoperative pacemaker implantation and 30-day all-cause mortality.

Results: A total of 372 patients (75 ± 6.3 years) with severe aortic valve stenosis underwent valve replacement either with the Edwards INTUITY valve (67.5%) or LivaNova Perceval (32.5%) valve. EuroSCORE II was 4.1 ± 5.1% in our cohort. Thirty-day all-cause mortality was 3.5%. No incidence of postoperative thrombosis or myocardial infarctions was observed. Four patients (1.1%) suffered stroke after the procedure performed. Mean length of ICU stay was 4 ± 5.1 days and the length of in-hospital stays was 8.2 ± 7.6.

No residual aortic valve regurgitation was observed in 362 patients (97.2%). Ten patients (2.7%) presented mild paravalvular regurgitation. Average pressure gradients were pmean/pmax 10.4 ± 5.0/19.8 ± 8.7 mm Hg. Seventy-six patients (19.8%) presented preoperative conduction disorders.

In total 60 patients (16.1%) underwent PPI after RDAVR. Follow-up showed that the pacemaker dependency after 9 years accounted for 50%. An amount of 40% did not present any stimulation fraction. 10% showed intermittent stimulation.

Conclusion: The incidence of PPI after RDAVR remains relatively high compared with conventional AVR. However, a significant number of patients recover from AV conduction disorders after RDAVR. Our findings relativize the high percentage of PPI following RDAVR and might contribute to a less aggressive indication for PPI after RDAVR.

Publication History

Article published online:
03 February 2022