Borut Geršak1,2, Mattia Glauber3, Denis Bouchard4, Jure Jug1, Marco Solinas5. 1. 37663 School of Medicine, University of Ljubljana, Slovenia. 2. Nisteri Medicine and Research, Phoenix, AZ, USA. 3. 46769 Istituto Clinico Sant'Ambrogio - Clinical & Research Hospital IRCCS - Gruppo Ospedaliero San Donato, Milano, Italy. 4. 25465 Montreal Heart Institute, Montreal, Canada. 5. 366975 Ospedale del Cuore-Fondazione Monasterio, Massa-Pisa, Italy.
Abstract
OBJECTIVE: Cardiac conduction system disturbances potentially leading to permanent pacemaker implantation are significant postoperative complications after aortic valve replacement. The aim of this study was to assess the impact of sutureless prosthetic valve oversizing on permanent pacemaker implantation rate. METHODS: This multicenter retrospective study included 306 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve. Oversizing was determined by the implanted valve size indexed to body surface area. Data were analyzed with a multivariable logistic regression model. RESULTS: This study confirmed excellent postoperative results for minimally invasive aortic valve replacement with right anterior minithoracotomy approach and rapid deployment sutureless valves. Mortality rate was 1%. Eighteen (5.9%) patients received a new permanent pacemaker. Multivariable logistic regression model (P = 0.05) found oversizing as significant risk factor (P = 0.017) for permanent postoperative pacemaker implantation independent of patient age. There was a significant negative correlation between the indexed implanted valve size and the mean and peak postoperative transvalvular gradients (P < 0.001). CONCLUSIONS: Oversizing of sutureless prosthetic aortic valves is a risk factor for postoperative permanent pacemaker implantation. Proper sizing of Perceval is important to avoid complications and ensure optimal valve performance.
OBJECTIVE: Cardiac conduction system disturbances potentially leading to permanent pacemaker implantation are significant postoperative complications after aortic valve replacement. The aim of this study was to assess the impact of sutureless prosthetic valve oversizing on permanent pacemaker implantation rate. METHODS: This multicenter retrospective study included 306 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve. Oversizing was determined by the implanted valve size indexed to body surface area. Data were analyzed with a multivariable logistic regression model. RESULTS: This study confirmed excellent postoperative results for minimally invasive aortic valve replacement with right anterior minithoracotomy approach and rapid deployment sutureless valves. Mortality rate was 1%. Eighteen (5.9%) patients received a new permanent pacemaker. Multivariable logistic regression model (P = 0.05) found oversizing as significant risk factor (P = 0.017) for permanent postoperative pacemaker implantation independent of patient age. There was a significant negative correlation between the indexed implanted valve size and the mean and peak postoperative transvalvular gradients (P < 0.001). CONCLUSIONS: Oversizing of sutureless prosthetic aortic valves is a risk factor for postoperative permanent pacemaker implantation. Proper sizing of Perceval is important to avoid complications and ensure optimal valve performance.
Authors: Mohammad Yousuf Salmasi; Sruthi Ramaraju; Iqraa Haq; Ryan A B Mohamed; Taimoor Khan; Faruk Oezalp; George Asimakopoulos; Shahzad G Raja Journal: J Card Surg Date: 2022-01-14 Impact factor: 1.778