Does Surgical Technique in Aortic Valve Replacement Surgery Have an Impact on Rates of Postoperative Conduction Defects Requiring Permanent Pacemaker Implantation

Abstract

Background: Surgical aortic valve replacement (SAVR) is a well-established procedure in the treatment of severe aortic stenosis [[1]Nishimura R.A. Otto C.M. Bonow R.O. et al.AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63 (e57-e185. 2)Crossref Scopus (1404) Google Scholar]. Conduction defects are a known complication of SAVR [[2]Totaro P. Calamai G. Montesi G. Barzaghi C. Vaccari M. Continuous Suture Technique and Impairment of the Atrioventricular Conduction After Aortic Valve Replacement.Journal of Cardiac Surgery. 2000; 15: 418-422Crossref PubMed Scopus (28) Google Scholar]. There is a paucity of data on the effect of suturing technique on incidence for permanent pacemaker (PPM) implantation due to complete heart block. Only one paper could be identified which directly compared the two methods, suggesting an increased rate associated with the continuous suturing technique [[2]Totaro P. Calamai G. Montesi G. Barzaghi C. Vaccari M. Continuous Suture Technique and Impairment of the Atrioventricular Conduction After Aortic Valve Replacement.Journal of Cardiac Surgery. 2000; 15: 418-422Crossref PubMed Scopus (28) Google Scholar]. We investigated the difference in PPM implantation rates in continuous and interrupted suturing techniques. Methods: All patients undergoing SAVR ± coronary artery bypass graft (CABG) operations from 05/10/1997 to 30/04/2014 in Morriston Hospital (Swansea, UK) were identified from the cardiothoracic database. Patients with other valve replacement, infective endocarditis or aortic surgery were excluded. This was correlated with a database which showed all PPM procedures performed at the same institution. Patients who underwent either isolated SAVR ± CABG and required a PPM within 90 days of the operation were identified. Results: 2456 operations were performed in the study period. The interrupted suturing technique was used in 62.5% and continuous suturing technique in 37.5% of cases. There was no significant difference in the need for PPM within 90 days between interrupted suturing (2.5%) and continuous suturing techniques (2.7%), p = 0.79. There was no difference in mortality, 2.5% in the interrupted group compared to 3.3% continuous group, p = 0.31. Cardiopulmonary bypass time was shorter by 16 minutes for the continuous suturing method, p < 0.01. Conclusion: In this retrospective single centre cohort study there was no statistically significant difference in the need for PPM implantation within 90 days between the continuous and interrupted suturing methods, similarly there was no difference in mortality, suggesting that either method can be used with similar outcomes in mortality and post-op PPM implantation.