Incidence Of Pacemaker Implantation After Aortic Valve Replacement With Sutureless Prosthesis: Single Centre Experience
Gabriele Di Giammarco, MD, Daniele Marinelli, MD, Francesca Faragalli, MD, Valentina Mancini, MD, Donato Micucci, MD.
Cardiac Surgery department-University “G.D'Annunzio” Chieti-Pescara, Italy, Chieti, Italy.
BackgroungPacemaker(PMK) implantation after surgical aortic valve replacement(SAVR) occures rarely. In Transcatheter aortic valve replacement(TAVR)PMK implantation is one of the most common complications due to a lesion at the level of AV conduction system.One of the most relevant innovations in SAVR is the introduction of sutureless bioprosthetic valve.The mechanism of valve fixation is based on the radial forces generated from the nitinol stent.Consequently,it can be hypothesized that this could represent the mechanism of a compression at the level of membranous septumthat may produce a AV block with the need for PMK.We retrospectively reviewed the incidence of PMK implantation immediately after and during the followup of sutureless SAVR and the variation of EKG QRS and PR interval duration. MethodsFrom February 2015 to October 2017, 67 patients submitted to isolated or combined SAVR were included in the study. Patients who had received PMK preoperatively (2 patients) were excluded from the analysis.The QRS and PR interval duration was analyzed in preoperative,1° postoperative and pre-discharge electrocardiograms (EKG).The follow-up was obtained in outpatient clinical controls.One-way ANOVA and Kaplan Meier analyses were used.A p≤0.05 was considered statistically significant.ResultsMean age of the study group was 74±9 years.The number of isolated SAVR was 35.The most common associated procedure was concomitant coronary artery bypass grafting (CABG)(28 patients;42%). The rate of PMK implantation in the postoperative period was 4.5% (3 patients in the time period of 1 to 5 days).No patient has PMK implantation in the mid-term follow-up (mean follow-up 313±200 days).Actuarial freedom from PMK implantation at 1000 days was 95.4%.An increase of the QRS duration was observed in the postoperative period(100 ms, 107.4 and 106.4 ms in the preop,1° postoperative and discharge EKG respectively, p=0.049).The PR interval did not show any change at the same time intervals. ConclusionsPMK implantation after Sutureless-SAVR is an uncommon complication and in our experience it was limited to the immediate postoperative period.In our patients there was no need for PMK during followup as compared to a reported incidence of 4% PMK implantation in the TAVR followup.In conclusion sutureless-SAVR is a safe procedure as of the rate of postoperative PMK implantation similarly to what happens after sutured prosthesis SAVR. 
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