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Conduction disorders after aortic valve replacement: what is the real impact of sutureless and rapid deployment valves?
- Source :
- Ann Cardiothorac Surg
- Publication Year :
- 2020
-
Abstract
- Background: Although sutureless and rapid deployment aortic valve replacement (SURD-AVR) has been associated with an increased rate of permanent pacemaker (PPM) implantation compared to conventional AVR (c-AVR), the predictors of new conduction abnormalities remain to be clarified. This study aimed to identify risk factors for conduction disorders in patients undergoing AVR surgery. Methods: Data from 243 patients receiving minimally invasive AVR were prospectively collected. SURD-AVR was performed in 103 (42.4%) patients and c-AVR in 140 (57.6%). The primary endpoint was the occurrence of new-onset conduction disorders, defined as first degree atrioventricular (AV) block, advanced AV block requiring PPM implantation, left anterior fascicular block (LAFB), left bundle branch block (LBBB) and right bundle branch block (RBBB). Results: The unadjusted comparison revealed that SURD-AVR was associated with a higher rate of advanced AV block requiring PPM when compared with c-AVR (10.5% vs. 2.1%, P=0.01). After adjusting for other measured covariates (OR: 1.6, P=0.58) and for the estimated propensity of SURD-AVR (OR: 5.1, P=0.1), no significant relationship between type of AVR and PPM implantation emerged. On multivariable analysis, preoperative first-degree AV block (OR: 6.9, P=0.04) and RBBB (OR: 6.9, P=0.03) were independent risk factors for PPM. Subgroup analysis of patients with normal preoperative conduction revealed similar incidence of PPM between SURD-AVR and c-AVR (1.3% vs. 1.9%, P=0.6). When compared with c-AVR, SURD-AVR was associated with a greater incidence of postoperative new onset LBBB (18.1% vs. 3.2%, P
- Subjects :
- medicine.medical_specialty
Conduction disorders
Subgroup analysis
030204 cardiovascular system & hematology
rapid deployment aortic valve replacement
conduction disorder
New onset
03 medical and health sciences
0302 clinical medicine
Aortic valve replacement
Internal medicine
medicine
Left bundle branch block
business.industry
Incidence (epidemiology)
Right bundle branch block
Featured Article
medicine.disease
030228 respiratory system
aortic valve replacement (AVR)
Cardiology
Sutureless aortic valve replacement
Surgery
Left anterior fascicular block
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Ann Cardiothorac Surg
- Accession number :
- edsair.doi.dedup.....767d9eafe145363d329e9b371772e673