P344 OCCURRENCE OF PERMANENT PACE–MAKER IMPLANTATION DURING HOSPITALIZATION AFTER INTUITY RAPID DEPLOYMENT AORTC BIOPROSTHESIS IMPLANTATION: A RETROSPECTIVE SINGLE CENTER STUDY

Abstract

Abstract Between March 2017 and June 2020, 97 consecutive patients underwent aortic valve replacement (AVR) with the Edwards Intuity and its evolution Intuity Elite rapid deployment bioproshesis were enrolled at the Cardio Surgery Department at the “San Carlo” Hospital in Potenza. A total of nine patients were excluded: 3 patients for incomplete data, 3 patients because they already had a pacemaker at the time of admission, and other 3 patients because they underwent combined aortic and mitral valve surgery. The remaining 88 patients were evaluated. Among these, 62 (70%) underwent insolated AVR and the remaining 26 (30%) combined procedure with myocardial revascularization, performed through mini–sternotomy or full sternotomy respectively. Population was divided into two groups according to the date of surgery: before (N: 66, 75%), group A, and after (N: 22,25%), group B, September 2019, when we modified prosthesis implantation technique in order to reduce the incidence of permanent pacemaker implantation (PPI), with a particular attention in annular decalcification compared to standard technique near to the interventricular septum, in order to prevent hard calcium block compression on conduction system. Subjects underwent serial ECGs at baseline, after the intervention and every 24 hours until hospital discharge, moreover they had continuous monitoring till discharge. ECG Holter monitoring were prescribed during the first year after discharge if any alteration at basal ECG were observed. The policy for PPI followed the current guidelines. All the ECGs and the Holter monitoring were analyzed by two independent physicians blinded to each other’s. At the end of our study, we observed 4 PPI in the group A, 3 cases for complete AV block (third degree AV block) and one case for tachy–brady syndrome about four months after the AVR, no PPI were observed in the group B. In conclusion the new technique of aortic valve decalcification during INTUITY rapid deployment bioprosthesis implantation, introduced in our institution in September 2019, provided to be safe and effective in reducing the occurrence of cardiac conduction disorders and consequently of PPI compared to standard technique.