title: Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement.
abstract: In high-risk patients with severe aortic stenosis, aortic valve replacement (AVR) with a sutureless Perceval prosthesis (SU-AVR) can be performed instead of conventional AVR or transcatheter aortic valve implantation. Little data are available regarding postoperative conduction disorders after SU-AVR. We aimed to determine the incidence and predictors of new-onset complete atrioventricular block (NO-AVB) requiring permanent cardiac stimulation following SU-AVR.
  
  
  
  We studied consecutive patients who underwent SU-AVR between 2013 and 2015. Early patients underwent partial aortic decalcification and subannular valve implantation (standard technique), while later patients underwent complete/symmetrical decalcification and intra-annular valve deployment (modified technique). Predictive baseline and procedural variables and electrocardiographic parameters were identified using a logistic regression model.
  
  
  
  We included 140 patients (mean age, 78 ± 6.5 years; mean Log EuroSCORE II, 8.9 ± 10%; 28.6% concomitant myocardial revascularization). The most common postoperative conduction disturbances were LBBB (25%), NO-AVB (12.1%) and first-degree atrioventricular block (AVB) (7.9%). The incidence of NO-AVB was 61% lower with the modified versus the standard technique (P= 0.04). NO-AVB predominantly appeared within 24 h post-surgery, occurring >24 h post-surgery in only 2 patients (both with baseline conduction defects). Independent predictors of NO-AVB included baseline left QRS axis deviation (LaQD; P= 0.03), first-degree AVB (P< 0.01) and standard surgical technique (P= 0.02).
  
  
  
  NO-AVB is a frequent complication following SU-AVR, and its incidence strongly depends on the surgical technique. Baseline first-degree AVB and LaQD independently predict NO-AVB and should be considered when deciding the duration of postoperative electrocardiographic monitoring.
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Beatriz
authors: B
authors: Toledano
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain f.bisbalvb@gmail.com.
authors: Felipe
authors: F
authors: Bisbal
authors: Department of Cardiac Surgery, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Maria Luisa
authors: ML
authors: Camara
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Carlos
authors: C
authors: Labata
authors: Department of Cardiac Surgery, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Elisabet
authors: E
authors: Berastegui
authors: ICREC Research Program, Health Science Research Institute Germans Trias i Pujol, Badalona, Spain.
authors: Carolina
authors: C
authors: Gálvez-Montón
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Roger
authors: R
authors: Villuendas
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Axel
authors: A
authors: Sarrias
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Teresa
authors: T
authors: Oliveres
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Damià
authors: D
authors: Pereferrer
authors: Department of Cardiac Surgery, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Xavier
authors: X
authors: Ruyra
authors: Department of Cardiology, Heart Institute-Hospital Germans Trias i Pujol, Badalona, Spain.|ICREC Research Program, Health Science Research Institute Germans Trias i Pujol, Badalona, Spain.
authors: Antoni
authors: A
authors: Bayés-Genís
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D054537:Atrioventricular Block / Q000453:epidemiology* / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D010138:Pacemaker, Artificial; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic stenosis; Aortic valve replacement; Atrioventricular block; Monitoring; Postoperative; Suturless Perceval prosthesis