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Push Down Technique To Avoid Complete Atrioventricular Blok In Sutureless Aortic Valve Replacement
Yoshitsugu Nakamura, Taisuke Nakayama, Yujiro Ito;
Chibanishi general hospital, Chiba, Japan
BACKGROUND: Sutureless aortic valve replacement (SUAVR) with Perceval valve (Corcym) is associated with increased rate of complete atrioventricular block (CAVB) compared to conventional AVR. We developed the push-down technique (PDT) to minimize CAVB rate after SUAVR. The aim of this study is to assess impact of PDT on CAVB rate after SUAVR.
METHODS: Surgical technique of PDT: In Perceval deployment, a primary surgeon holds the Perceval holder shaft in the left hand and the forceps in the right hand. A remnant of commissure of the right and non-coronary cusp is grasped by the forceps in the surgeon’s right hand. Then the commissure is pushed down toward the left ventricle and held at the level of the supra-annular cuff of the Perceval. The first assistant rotates the knob of the Perceval holder to open the inflow ring. As a result, the conduction system is positioned below the inflow ring. Other procedures of SUAVR are the same as regular fashion. We conducted a retrospective review of 137 SUAVR cases using PDT at our institution from Nov 2019 to May 2023.
RESULTS: Mean age of the patients were 76.7±5.1 years. 76 males (55.4%) were male. Mean euroSCORE II was 3.2 +/- 2.7. Preoperative ECG showed right bundle branch block in 11 patients (8.0%) and left bundle branch block in 4 patients (2.9%). 61 (43.1%) patients underwent minimally invasive approach, whereas 78 (56.9%) patients underwent median sternotomy. 48 patients (35.0%) underwent concomitant procedures such as CABG or mitral valve procedure. Cross clamp time was 64 +/-22 min. There was 2 hospital death (1.5%). There was no new-onset permanent CAVB (0%) and 3 temporary CAVB (2.2%). One patient had new-onset left bundle branch block. No patients (0%) required new permanent pacemaker implantation during hospitalization.
CONCLUSIONS: PDT is an effective and simple technique to avoid postoperative CAVB in SUAVR.
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