title: Conduction Disorders After Sutureless Aortic Valve Replacement.
abstract: BACKGROUND
  Sutureless self-expandable aortic bioprostheses rely on radial forces for stabilization, raising concern that these devices may increase the risk of postoperative conduction disease. The purpose of this study was to determine the incidence of conduction disorders after sutureless aortic valve replacement (AVR) with the Perceval S (Sorin Group, Saluggia, Italy) bioprosthesis.
  
  
  METHODS
  Between June 2011 and March 2013, 108 consecutive patients underwent sutureless AVR with the Perceval S prosthesis. Six patients (6%) had a permanent pacemaker (PPM) preoperatively and were excluded from the present study. Mean electrocardiographic follow-up was 14.6 ± 6.0 months.
  
  
  RESULTS
  Mean age was 79.2 ± 4.8 years (52% female). During the postoperative period, 34 patients (34%) had first-degree atrioventricular block, 2 (2%) had Mobitz-II atrioventricular block, and 16 (16%) had complete atrioventricular block. New-onset left bundle branch block and right bundle branch block were observed in 33 patients (33%) and 22 patients (22%), respectively. Inhospital postoperative PPM implantation was required in 23 patients (23%). Preoperative aortic valve area, age more than 85 years, and preoperative right bundle branch block were found to be independently associated with inhospital PPM implantation or new-onset postoperative conduction disorder. At follow-up, 3 more patients (3%) underwent PPM implantation. The cumulative incidences of PPM dependency and ventricular pacing more than 25% of the time were 18% ± 11% and 21% ± 10%, respectively, at 18 months.
  
  
  CONCLUSIONS
  In the present study, the postoperative PPM implantation rate (23%) after sutureless AVR with the Perceval S prosthesis was high. Surgical strategies aimed at mitigating this risk should be further investigated.
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: Bouhout
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.affiliation: Division of Electrophysiology, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Lena
authors.initials: L
authors.lastname: Rivard
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Aly
authors.initials: A
authors.lastname: Ghoneim
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: El-Hamamsy
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.affiliation: Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D001705:Bioprosthesis / Q000009:adverse effects*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D000071062:Sutureless Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome