Ferdinand Vogt1, Steffen Pfeiffer1, Angelo Maria Dell'Aquila2, Theodor Fischlein1, Giuseppe Santarpino3. 1. Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany. 2. Department of Cardiac Surgery, University Hospital, Münster, Germany. 3. Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany giuseppe.santarpino@klinikum-nuernberg.de g.santarpino@libero.it.
Abstract
OBJECTIVES: Aortic valve replacement (AVR) with sutureless bioprostheses has become an alternative to conventional AVR for patients with intermediate to high operative risk. However, this technique is associated with an increased risk of postoperative conduction disorders. METHODS: We analysed 258 patients who underwent AVR with the Perceval prosthesis from July 2010 to September 2014 at our centre. Electrocardiography were obtained at baseline to record preoperatively the presence of conduction disorders. Preoperative risk factors, intraoperative procedures and complications (61 variables) were compared between patients with permanent pacemaker (PPM group) and without (no-PPM group) need for postoperative PPM implantation. RESULTS: One hundred and sixty-nine patients underwent isolated AVR with the Perceval bioprosthesis, 89 patients had associated surgery and 23 patients underwent redo operations. The mean age was 77.7 ± 5 years, 139 patients were female (46%) and the mean logistic EuroSCORE was 13.2 ± 11%. At baseline, 8 patients had already an implanted pacemaker. Postoperatively, 27 patients (10.5%) required new PPM implantation due to complete atrioventricular block. On univariate analysis, age (PPM vs no-PPM group: 80 ± 5 vs 77 ± 5 years, P = 0.009) and preoperative presence of right bundle branch block (RBBB) [overall n = 20 (7.8%); PPM vs no-PPM group: 9 vs 11 (33 vs 4.8%); P < 0.001] were identified as independent predictors of postoperative conduction disorders, but only pre-existing RBBB persisted on multivariate analysis (odds ratio 11.3-C-statistic 0.74, error estimate 0.064, confidence interval 0.672-0.801; P = 0.0002). Among patients undergoing sutureless AVR, the rate of PPM implantation was high. CONCLUSIONS: The analysis of the data collected made it possible to identify preoperatively a subset of patients undergoing sutureless AVR at higher risk of postoperative atrioventricular block. Additional surgical precautions should be implemented to prevent the occurrence of conduction disorders after sutureless AVR.
OBJECTIVES: Aortic valve replacement (AVR) with sutureless bioprostheses has become an alternative to conventional AVR for patients with intermediate to high operative risk. However, this technique is associated with an increased risk of postoperative conduction disorders. METHODS: We analysed 258 patients who underwent AVR with the Perceval prosthesis from July 2010 to September 2014 at our centre. Electrocardiography were obtained at baseline to record preoperatively the presence of conduction disorders. Preoperative risk factors, intraoperative procedures and complications (61 variables) were compared between patients with permanent pacemaker (PPM group) and without (no-PPM group) need for postoperative PPM implantation. RESULTS: One hundred and sixty-nine patients underwent isolated AVR with the Perceval bioprosthesis, 89 patients had associated surgery and 23 patients underwent redo operations. The mean age was 77.7 ± 5 years, 139 patients were female (46%) and the mean logistic EuroSCORE was 13.2 ± 11%. At baseline, 8 patients had already an implanted pacemaker. Postoperatively, 27 patients (10.5%) required new PPM implantation due to complete atrioventricular block. On univariate analysis, age (PPM vs no-PPM group: 80 ± 5 vs 77 ± 5 years, P = 0.009) and preoperative presence of right bundle branch block (RBBB) [overall n = 20 (7.8%); PPM vs no-PPM group: 9 vs 11 (33 vs 4.8%); P < 0.001] were identified as independent predictors of postoperative conduction disorders, but only pre-existing RBBB persisted on multivariate analysis (odds ratio 11.3-C-statistic 0.74, error estimate 0.064, confidence interval 0.672-0.801; P = 0.0002). Among patients undergoing sutureless AVR, the rate of PPM implantation was high. CONCLUSIONS: The analysis of the data collected made it possible to identify preoperatively a subset of patients undergoing sutureless AVR at higher risk of postoperative atrioventricular block. Additional surgical precautions should be implemented to prevent the occurrence of conduction disorders after sutureless AVR.
Authors: Antonino S Rubino; Giuseppe Santarpino; Herbert De Praetere; Keiichiro Kasama; Magnus Dalén; Ulrik Sartipy; Jarmo Lahtinen; Jouni Heikkinen; Wanda Deste; Francesco Pollari; Peter Svenarud; Bart Meuris; Theodor Fischlein; Carmelo Mignosa; Fausto Biancari Journal: J Thorac Cardiovasc Surg Date: 2014-04-04 Impact factor: 5.209
Authors: G Gregoratos; M D Cheitlin; A Conill; A E Epstein; C Fellows; T B Ferguson; R A Freedman; M A Hlatky; G V Naccarelli; S Saksena; R C Schlant; M J Silka Journal: Circulation Date: 1998-04-07 Impact factor: 29.690
Authors: Astrid G M van Boxtel; Patrick Houthuizen; Mohamed A Soliman Hamad; Jelena Sjatskig; Erwin Tan; Frits W Prinzen; Albert H M van Straten Journal: J Heart Valve Dis Date: 2014-05
Authors: Amine Mazine; Kevin Teoh; Ismail Bouhout; Gopal Bhatnagar; Marc Pelletier; Pierre Voisine; Philippe Demers; Michel Carrier; Denis Bouchard Journal: Can J Cardiol Date: 2014-10-31 Impact factor: 5.223
Authors: Willem Flameng; Marie-Christine Herregods; Hadewich Hermans; Gerry Van der Mieren; Monique Vercalsteren; Gert Poortmans; Jan Van Hemelrijck; Bart Meuris Journal: J Thorac Cardiovasc Surg Date: 2011-04-07 Impact factor: 5.209
Authors: J H McAnulty; S H Rahimtoola; E Murphy; H DeMots; L Ritzmann; P E Kanarek; S Kauffman Journal: N Engl J Med Date: 1982-07-15 Impact factor: 91.245
Authors: Kei Woldendorp; Mathew P Doyle; Paul G Bannon; Martin Misfeld; Tristan D Yan; Giuseppe Santarpino; Paolo Berretta; Marco Di Eusanio; Bart Meuris; Alfredo Giuseppe Cerillo; Pierluigi Stefàno; Niccolò Marchionni; Jacqueline K Olive; Tom C Nguyen; Marco Solinas; Giacomo Bianchi Journal: Ann Cardiothorac Surg Date: 2020-09
Authors: Miguel González Barbeito; Francisco Estévez-Cid; Patricia Pardo Martínez; Carlos Velasco García de Sierra; Carmen Iglesias Gil; Cristina Quiñones Laguillo; José Joaquín Cuenca Castillo Journal: J Thorac Dis Date: 2019-07 Impact factor: 2.895
Authors: Declan Lloyd; Jessica G Y Luc; Ben Elias Indja; Vannessa Leung; Nelson Wang; Kevin Phan Journal: J Thorac Dis Date: 2019-01 Impact factor: 2.895
Authors: Ka Yan Lam; Naomi Timmermans; Ferdi Akca; Erwin Tan; Niels J Verberkmoes; Kim de Kort; Mohamed Soliman-Hamad; Albert H M van Straten Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10