Thorac Cardiovasc Surg 2016; 64 - ePP126
DOI: 10.1055/s-0036-1571773

Does Rhythm Recover after Pacemaker Implantation for Atrioventricular Conduction Disorder after Sutureless Aortic Valve Replacement?

E. Beckmann 1, F. Alhadi 1, K. Hoeffler 1, S. Sarikouch 1, N. Koigeldiev 1, K. T. Kaufeld 1, J. Umminger 1, M. Shrestha 1, A. Haverich 1, A. Martens 1
  • 1Hannover Medical School, Cardiothoracic, Transplantation and Vascular Surgery, Hannover, Germany

Objectives: The majority of patients receiving permanent pacemaker (PM) implantation after conventional aortic valve replacement (AVR) do not recover from atrioventricular (AV) conduction disorder. The new generation of self-expandable sutureless aortic valve prostheses offers benefits in terms of reduced cardiac ischemia times, but leads to a higher rate of postoperative AV conduction disorders. Whether these patients recover from AV conduction disorders is not clear. This study analyzes the long-term PM dependency and recovery from AV conduction disorders during follow-up in patients receiving sutureless aortic valve prosthesis.

Methods: Between June 2010 and August 2013, a total of 105 patients underwent AVR with a sutureless Sorin Perceval® prosthesis at our center. Of these, 18 patients (17%, mean age 78 ± 5 years, 22% female) developed a significant conduction disorder necessitating PM implantation. Preoperative electrocardiogram (ECG) showed normal sinus rhythm in 39% (n = 7), right bundle branch block in 22% (n = 4), left anterior hemiblock in 17% (n = 3), bifascicular block (n = 3) in 17% and atrial fibrillation in 5% (n = 1) of patients. PM implantation was performed after a mean of 3.9 ± 3.6 days following surgery. PM dependency was analyzed by ECG and PM check during follow-up.

Results: Follow up was complete for all patients. One patient died early during follow-up. The mean follow-up time was 1.6 ± 2.2 years. Only 12% (n = 2) of patients were no longer pacemaker-dependent. The majority (88%, n = 15) was still pacemaker dependent with a permanent or significant intermittent need for ventricular stimulation.

Conclusion: The majority of patients that develop a significant AV conduction disorder after implantation of a sutureless aortic valve prosthesis do not recover. In case AV conduction disorder develops after sutureless AVR, we recommend early PM implantation.