Early pacemaker insertion after aortic valve replacement with an Edwards Intuity sutureless valve - 10/11/22
, Raphaël Demoulin b, Pierre Dieuzaide a, Angélique Peret a, Alain Vaillant c, Jacques Vicat c, Ahmed Bouharaoua a, Elisabeth Leude-Vaillant c, Alain Cornen c, Sébastien Prevot a
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Graphical abstract |
Central illustration. Increase in pacemaker insertion and new bundle branch block (BBB) in patients implanted with an Intuity valve compared with those who received a standard surgical aortic valve.
Highlights |
• | The rate of early pacemaker insertion was significantly higher in patients who received an Intuity sutureless aortic valve in comparison to those who received a standard bioprosthetic aortic valve. |
• | The main indications for pacemaker insertion were complete atrioventricular block and left bundle branch block with prolongation of the HV interval. |
• | The rate of new postoperative left bundle branch block conduction disorders was significantly higher in patients implanted with an Intuity valve. |
Abstract |
Background |
Postoperative conduction disorders are serious adverse events in patients undergoing aortic valve replacement, and may prolong the duration of hospitalization and require pacemaker insertion.
Aim |
Our aim was to evaluate the rate of pacemaker insertion after implantation of an Edwards Intuity sutureless aortic valve (Edwards Lifesciences, Irvine, CA, USA) compared with a standard surgical bioprosthesis.
Methods |
This retrospective single-centre study included patients who underwent aortic valve replacement with an Intuity sutureless aortic valve or a standard bioprosthetic valve between 4 June 2014 and 27 June 2016. The main outcome criterion was the rate of postoperative pacemaker insertion. Secondary outcome criteria included the rate of new conduction disorders, the rate of atrial arrhythmia or paroxysmal conduction disorders, mortality and duration of hospital stay.
Results |
Ninety-three patients received an Intuity sutureless aortic valve (median age 76 years, interquartile range 71–80 years), and 176 were implanted with a standard biological aortic valve (median age 73 years, interquartile range 68–79 years; P=0.007). The rate of postoperative pacemaker insertion, after adjustment, was 22.44% in the Intuity group and 5.66% in the standard aortic valve group (P=0.030). The main indications for postoperative pacemaker insertion were complete atrioventricular block and left bundle branch block with prolongation of the H-V interval. The rate of new postoperative left bundle branch block conduction disorders was significantly higher in patients implanted with an Intuity valve (odds ratio 5.28, 95% confidence interval 1.59 to 23.05; P=0.012).
Conclusion |
Higher rates of pacemaker insertion and new conduction disorders were observed in patients implanted with an Intuity sutureless bioprosthesis compared with those who received a standard surgical aortic valve.
Le texte complet de cet article est disponible en PDF.Keywords : Aortic valve replacement, Atrioventricular block, Bundle branch block, Sutureless valve, Pacemaker
Abbreviations : AoVR, AVB, BBB, CI, IQR, OR, TAVI
Plan
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Vol 115 - N° 10
P. 490-495 - octobre 2022 Retour au numéro
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