Key result
The modified Perceval S implantation technique reduced postoperative atrioventricular block requiring a permanent pacemaker compared to the standard technique (4.30% vs 10.14%; P=0.009).
Why the study?
The impact of modifying the Perceval S implantation technique on postoperative atrioventricular block requiring a permanent pacemaker was unknown.
Does a modified implantation technique reduce postoperative atrioventricular block requiring a permanent pacemaker in patients undergoing aortic valve replacement with PERCEVAL S?
Cohort (n=519)
No
Does a modified implantation technique reduce postoperative atrioventricular block requiring a permanent pacemaker in patients undergoing aortic valve replacement with PERCEVAL S?
Absolute Event Rate: 4.3% vs 10.14%
p-value: p=0.009
A modified implantation technique for the Perceval S sutureless aortic valve significantly reduces the incidence of postoperative atrioventricular block requiring a permanent pacemaker.
Should not yet change Perceval S implantation practice; leaves open randomized confirmation of reduced pacemaker implantation.
BACKGROUND: The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. METHODS: Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed. RESULTS: Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008). CONCLUSIONS: In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.
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González‐Barbeito et al. (2019) conducted a cohort in Aortic valve replacement (n=519). Modified Perceval S implantation technique vs. Standard technique was evaluated on Postoperative atrioventricular block requiring a permanent pacemaker (p=0.009). The modified Perceval S implantation technique reduced postoperative atrioventricular block requiring a permanent pacemaker compared to the standard technique (4.30% vs 10.14%; P=0.009).
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