Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement

• Published in: Interactive cardiovascular and thoracic surgery Vol. 23; no. 6; pp. 861 - 868
• Main Authors: Toledano, Beatriz, Bisbal, Felipe, Camara, Maria Luisa, Labata, Carlos, Berastegui, Elisabet, Gálvez-Montón, Carolina, Villuendas, Roger, Sarrias, Axel, Oliveres, Teresa, Pereferrer, Damià, Ruyra, Xavier, Bayés-Genís, Antoni
• Format: Journal Article
• Language: English
• Published: England 01.12.2016
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - surgery; Atrioventricular Block - epidemiology; Atrioventricular Block - therapy; Electrocardiography; Female; Heart Conduction System - physiopathology; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Humans; Incidence; Logistic Models; Male; Pacemaker, Artificial; Time Factors; Treatment Outcome; Postoperative; Aortic stenosis; Aortic valve replacement; Atrioventricular block; Monitoring; Suturless Perceval prosthesis
• ISSN: 1569-9293; 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivw259

In high-risk patients with severe aortic stenosis, aortic valve replacement (AVR) with a sutureless Perceval prosthesis (SU-AVR) can be performed instead of conventional AVR or transcatheter aortic valve implantation. Little data are available regarding postoperative conduction disorders after SU-AVR. We aimed to determine the incidence and predictors of new-onset complete atrioventricular block (NO-AVB) requiring permanent cardiac stimulation following SU-AVR. We studied consecutive patients who underwent SU-AVR between 2013 and 2015. Early patients underwent partial aortic decalcification and subannular valve implantation (standard technique), while later patients underwent complete/symmetrical decalcification and intra-annular valve deployment (modified technique). Predictive baseline and procedural variables and electrocardiographic parameters were identified using a logistic regression model. We included 140 patients (mean age, 78 ± 6.5 years; mean Log EuroSCORE II, 8.9 ± 10%; 28.6% concomitant myocardial revascularization). The most common postoperative conduction disturbances were LBBB (25%), NO-AVB (12.1%) and first-degree atrioventricular block (AVB) (7.9%). The incidence of NO-AVB was 61% lower with the modified versus the standard technique (P= 0.04). NO-AVB predominantly appeared within 24 h post-surgery, occurring >24 h post-surgery in only 2 patients (both with baseline conduction defects). Independent predictors of NO-AVB included baseline left QRS axis deviation (LaQD; P= 0.03), first-degree AVB (P< 0.01) and standard surgical technique (P= 0.02). NO-AVB is a frequent complication following SU-AVR, and its incidence strongly depends on the surgical technique. Baseline first-degree AVB and LaQD independently predict NO-AVB and should be considered when deciding the duration of postoperative electrocardiographic monitoring.