Key result
The novel suture AVR technique was associated with a significantly lower rate of postoperative permanent pacemaker implantation compared to the classic surgical technique (0.8% vs 3.4%; P=0.024).
Why the study?
AVR can lead to conduction abnormalities requiring permanent pacemaker implantation, warranting evaluation of whether a novel suture technique reduces early postoperative pacemaker needs compared with standard surgery.
Does a novel suture AVR technique reduce early postoperative permanent pacemaker implantation in patients undergoing isolated AVR and root disease?
Cohort (n=354)
Yes
Does a novel suture AVR technique reduce early postoperative permanent pacemaker implantation in patients undergoing isolated AVR and root disease?
Absolute Event Rate: 0.8% vs 3.4%
p-value: p=0.024
A novel suture technique for aortic valve replacement significantly reduces the need for early postoperative permanent pacemaker implantation compared to the standard surgical technique.
May suggest lower PPM rates with novel suture AVR; hypothesis-generating and requires randomized trials before any practice change.
Background: Aortic valve replacement (AVR) may complicate conduction abnormalities and require permanent pacemaker (PPM) implantation. New techniques that lessen this challenge may lead to the development of new approaches. Our objective was to evaluate the contemporary incidence of early postoperative PPM implantation in patients undergoing isolated AVR and root disease with the standard AVR surgical technique compared with the novel suture AVR technique. Methods: The clinical data of 354 patients (250 male, 104 female) who underwent surgery for isolated AVR and root disease in different referral cardiology departments in Tabriz, Iran, over 4 years were analyzed. Patients with preoperative significant conduction abnormalities were excluded from the study. The patients were evaluated for in-hospital mortality, postoperative PPM implantation, and their stay in the ICU after surgery. Results: The mean age of the patients was 52.46±16.13 years. Totally, 183 patients (51.7%) were operated on with the new suture AVR technique. In-hospital mortality was lower in this group than in the group that underwent the "classic" surgical technique (2.5% vs 3.7%). PPM implantation was required in 3 patients (0.8%) after the novel suture AVR technique, whereas it was needed in 12 patients (3.4%) in the other group (P=0.024). The mortality rate was 9 patients (2.5%) in group 1 and 13 patients (3.7%) in group 2, which was not statistically significant (P=0.296). According to the logistic regression, the survival rate in the group operated on with the classical surgical method was 0.27 times higher than that in the patients operated on with the new method. Conclusion: Permanent complete AV block is a critical complication after AVR surgery. A lower PPM requirement and higher survival in patients operated on with the new method was the main finding of this study. New techniques with lower PPM requirements may be suitable for cardiac surgery.
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Roshanravan et al. (2023) conducted a cohort in Isolated aortic valve replacement and root disease (n=354). Novel suture AVR technique vs. Standard AVR surgical technique was evaluated on Postoperative permanent pacemaker (PPM) implantation (p=0.024). The novel suture AVR technique was associated with a significantly lower rate of postoperative permanent pacemaker implantation compared to the classic surgical technique (0.8% vs 3.4%; P=0.024).
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