22 Incidence and predictors of permanent pacemaker insertion after perceval sutureless aortic valve implantation – a retrospective single-centre study

Background Sutureless aortic valve replacement surgery (SAVR) is considered in patients with aortic stenosis who would benefit from reduced cross clamp time, such as elderly and high-risk patients. It serves as an alternative surgical approach to standard surgical AVR and TAVI (Figure 1). Objective The purpose of this study was to evaluate the incidence of PM implantation following sutureless aortic valve replacement using the Perceval S bioprosthesis (Sorin Group, Saluggia, Italy). In addition we sought to evaluate whether there were any pre-operative predictive indicators to identify those patients at higher risk of PM implantation using this technique. Methods During the study period a total amount of 58 consecutive patients (male 43%, age 77.9 ± 4.9 years) with severe aortic stenosis having undergone SAVR were included. Twenty-eight patients (48%) underwent an isolated AVR procedure; in the rest of study population AVR was performed in combination with coronary artery bypass graft (CABG) in 26 patients (45%), surgical pulmonary vein isolation in 2 (3%), tricuspid valve replacement (TVR) in 1 (2%) and both TVR and mitral valve replacement (MVR) in 1 (2%). Full median sternotomy was performed in all patients. Results During a mean follow up of 13.8 ± 5.0 months (median 13 months), 14 patients (24.1%) underwent dual-chamber pacemaker (PM) implantation after the SAVR procedure. The mean time to PM implantation was 5.4 ± 3.6 days (median 5 days). Ten out of 14 (71%) were found completely PM-dependent after PM implantation. The comparison of pre-operative characteristics between PM group and no PM group highlighted that QRS duration, EuroSCORE II index and chronic renal dysfunction were significantly associated with postoperative PM implantation (respectively, p = 0.01, p = 0.02 and p = 0.03). Conclusions In conclusion, we have found that chronic renal disease and QRSd are significant predictors of PM insertion post-Perceval SAVR.