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Routine Placement Of Temporary Epicardial Pacing Leads Is Not Required After Minimally Invasive Aortic Valve Replacement
Hossein Amirjamshidi, Peter A. Knight.
University of Rochester Medical Center, Rochester, NY, USA.
BACKGROUND: Temporary epicardial leads are routinely placed after valve surgery, which is associated with infrequent, but life-threatening complications. Placement of temporary ventricular leads can be difficult during minimally invasive valve surgery. Our objective is to identify the risk of requiring urgent transvenous pacing wire placement following minimally invasive aortic valve replacement. METHODS: We performed a single center, retrospective, observational study including 359 individuals who underwent minimally invasive aortic valve replacement (mini-AVR) through right anterior mini thoracotomy between January 2015 and September 2019. Exclusion criteria include conversion to median sternotomy and concomitant procedures. Patients were grouped according to avoidance or insertion of epicardial pacing wires, and further subdivided based on the requirement for post-operative emergent temporary transvenous pacing or permanent pacemaker placement during the index admission. RESULTS: 242 (67.4 %) had a normal rhythm and acceptable AV conduction prior to chest closure and did not have insertion of epicardial pacing wires. Of those patients only 3 (1.2%) required emergent transvenous pacing and 6 (2.5 %) required non emergent transvenous pacing with or without permanent pacemaker placement during the index admission. 62 (17.3%) patients received only atrial epicardial pacing leads secondary to sinus bradycardia or junctional rhythm and 3 (4.8%) of those patients required permanent pacemaker placement due to sick sinus syndrome and 1 (1.6%) patient required non-emergent transvenous pacing and permanent pacemaker due to high grade AV heart block. 55 (15.3 %) patients received ventricular leads due to high grade AV heart block and 7 (12.7%) of those patients required permanent pacemaker placement during the index admission. CONCLUSIONS: Temporary epicardial lead insertion is not routinely required in minimally invasive aortic valve replacement in patients with normal rhythm and acceptable AV conduction prior to chest closure. In the absence of epicardial ventricular lead insertion, the chance of requiring urgent transvenous pacing wire placement during the index admission is 0.99%.
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