Permanent pacemaker implantation is never a benign complication after aortic valve replacement

Recovery from Conduction Abnormalities after Aortic Valve Replacement using Edwards Intuity

PURPOSE

This study investigated the incidences of various conduction abnormalities after rapid-deployment aortic valve replacement(RDAVR) using Edwards Intuity and the temporal changes of these abnormalities during the postoperative course.

DESCRIPTION

We modified the procedure by placing additional anchoring sutures and using a 5-mm videoscope to achieve 'complete annulus fitting'. Direct visual inspection by videoscopy inside and outside the valve guaranteed 'complete annulus fitting'.

EVALUATION

Overall 167 patients who underwent RDAVR during the study period were included in the analysis of postoperative conduction abnormalities. After RDAVR, third-degree atrioventricular block occurred in 18 patients(10.8%), but 15 patients recovered to sinus rhythm at median postoperative 10 days. Left or right bundle branch block occurred in 67 patients(40.1%), but 44 patients returned to their original rhythm at median postoperative 12 days. Delayed-onset conduction abnormalities occurred in 35 patients(21.0%) at median postoperative day 4, but they spontaneously regressed in 28 patients.

CONCLUSIONS

The incidence of conduction abnormalities after RDAVR was high, but most of these abnormalities spontaneously recovered. These good results may be attributed to our implantation technique.

Direct comparison of rapid deployment versus sutureless aortic valve replacement: a meta-analysis

Background

This meta-analysis was conducted to compare the procedural and early outcomes of aortic valve replacement (AVR) using rapid deployment valve (RD group) versus sutureless valve (SU group).

Methods

A literature search of 5 online databases was conducted. The primary outcomes were mean transvalvular pressure gradient (MPG) after AVR, the incidence of paravalvular leak (PVL) and the need for a permanent pacemaker implantation (PPI). The secondary outcomes included aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times, early mortality and other postoperative complications, such as atrial fibrillation, bleeding reoperation and stroke.

Results

Eight articles were included, and all outcomes except MPG after AVR in matched valve sizes were extracted from 7 studies (RD group =842 patients and SU group =1,386 patients). The pooled analysis demonstrated a lower MPG in the RD group than in the SU group, with mean difference (MD) of 2.64 mmHg. The pooled risk ratios of any PVL and grade ≥2 (or moderate) PVL were not significantly different between the groups; however, the incidence of PPI was significantly lower in the RD group than in the SU group, with a risk ratio of 0.69. The pooled analyses showed that the ACC and CPB times were significantly longer in the RD group than in the SU group, with weighted MDs of 8.74 (P<0.001) and 9.94 (P<0.001) minutes, respectively. The risks of early mortality and other postoperative complications were not significantly different between the groups.

Conclusions

AVR using RD valve was associated with better valve hemodynamics in terms of the MPG than AVR using SU valve, and better outcomes were observed in the RD group regarding PPI. Procedural times were longer in AVR using RD valve than SU valve. Early clinical outcomes showed no difference between RD and SU valve.