Incidence of Permanent Pacemaker Implantation after SAVR: A Comparison between Semi-Continuous and Interrupted Suturing Techniques at Peshawar Institute of Cardiology

Objectives: To compare the incidence of permanent pacemaker implantation between semi-continuous and interrupted suturing techniques after SAVR. Study design: Retrospective cohort study. Place and duration of study: Peshawar Institute of Cardiology, from January 2022 to December 2024. Methods: A total of 196 patients undergoing isolated SAVR were included in this study using hospital’s electronic medical record. Based on suturing technique, patients were divided into SCS Group (semi-continuous suturing group) (n=81) and IS Group (interrupted suturing group) (n=115). All the relevant demographics, clinical characteristics, and postoperative outcomes were recorded. The primary outcome was set as the incidence of permanent pacemaker implantation in the two groups within 30 days following the procedure. The primary outcomes were compared by applying the Fisher’s Exact Test, considering a p-value <0.05 as statistically significant. Results: Mean age of patients was 54.4 ± 6.9 years with 76% males in overall study population. Permanent pacemaker implantation occurred in 3 patients (2.6%) in the interrupted group, while no case was reported (0%) in the semi-continuous group and the difference did not reach statistical significance (Fisher’s Exact Test, p=0.28). Indications for implantation of three permanent pacemaker in the interrupted group were complete heart block (66.6%) and high-grade atrioventricular block (33.33%). Conclusion: Both suturing techniques were associated with a low/no incidence of permanent pacemaker implantation after SAVR, with no significant difference observed between two techniques. Selection of suturing technique may therefore be guided by surgeon/ institution own preference and operative considerations.