Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR

Pollari, Francesco; Berretta, Paolo; Albertini, Alberto; Carrel, Thierry; Teoh, Kevin; Meuris, Bart; Villa, Emmanuel; Kappert, Utz; Andreas, Martin; Solinas, Marco; Misfeld, Martin; Savini, Carlo; Fiore, Antonio; Shrestha, Malakh; Santarpino, Giuseppe; Martinelli, Gian Luca; Mignosa, Carmelo; Glauber, Mattia; Yan, Tristan; Fischlein, Theodor; Di Eusanio, Marco

doi:10.1055/s-0042-1757778

Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR

Author:

Pollari, Francesco

Berretta, Paolo ; Albertini, Alberto ; Carrel, Thierry ; Teoh, Kevin ; Meuris, Bart ; Villa, Emmanuel ; Kappert, Utz ; Andreas, Martin ; Solinas, Marco ; Misfeld, Martin ; Savini, Carlo ; Fiore, Antonio ; Shrestha, Malakh ; Santarpino, Giuseppe ; Martinelli, Gian Luca ; Mignosa, Carmelo ; Glauber, Mattia ; Yan, Tristan ; Fischlein, Theodor ; Di Eusanio, Marco

Keywords:

Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Respiratory System, Surgery, Cardiovascular System & Cardiology, aortic valve and root, surgery, complications, outcomes (includes mortality, morbidity), minimally invasive surgery (includes port access, mini-thoracotomy), AORTIC-VALVE-REPLACEMENT, Humans, Aortic Valve Stenosis, Heart Valve Prosthesis Implantation, Retrospective Studies, Research Report, Treatment Outcome, Heart Valve Prosthesis, Pacemaker, Artificial, Prosthesis Design, Aortic Valve, Sutureless Surgical Procedures, 1102 Cardiorespiratory Medicine and Haematology, 3201 Cardiovascular medicine and haematology, 3202 Clinical sciences

Abstract:

OBJECTIVES: The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR). METHODS: We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group ("EG" = 2008-2016) and a late group ("LG" = 2017-2019). RESULTS: The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, p < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of associated procedures, and more frequent use of smaller prostheses were observed over time. In the RD cohort, the rate of PPI was stable over time (EG = 8.8% vs LG = 9.3%, p = 0.8). In this cohort, a younger age, lower risk profile, and higher incidence of concomitant septal myectomy were observed over time. CONCLUSION: Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.