New postoperative conduction abnormalities after the implantation of a rapid-deployment aortic valve prosthesis

Abstract

Objectives: Sutureless and rapid-deployment aortic valves have enlarged the selection of prostheses available for surgical aortic valve replacement. However, the rate of postoperative pacemaker implantation seems to have increased.

Methods: In addition to pacemaker implantation, we were interested in the incidence of new postoperative conduction abnormalities, namely left bundle branch block, right bundle branch block and atrioventricular block III after the implantation of the EDWARDS INTUITY Elite™ sutureless prosthesis. All patients undergoing isolated or concomitant surgical aortic valve replacement between May 2014 and May 2017 were included in the study.

Results: Two hundred patients were operated on. Of them, 14 patients dropped out because of concomitant endocardial or epicardial ablation or because of septal myectomy. Three more patients dropped out because the treatment was converted to conventional aortic valve replacement, and 183 patients remained. At the time of discharge from hospital, 38.1% of the 183 patients had new left bundle branch block, 2.5% of patients had new right bundle branch block and 9.6% had atrioventricular block III requiring either a pacemaker or defibrillator. The postoperative mean transvalvular gradient over the prosthesis was 8.4 ± 3.4 mmHg, the occurrence of paravalvular leakage more than trivial was 1% and hospital mortality was 3.3%.

Conclusions: The incidence of new postoperative conduction abnormalities is considerable with the EDWARDS INTUITY Elite rapid-deployment aortic valve prosthesis. We will focus our future research on the follow-up of patients with postoperative left bundle branch block, which was the most frequently observed form of new conduction abnormality.

Keywords: Conduction abnormalities; Left bundle branch block; Sutureless aortic valve prosthesis.