Prótesis sin sutura: ¿es posible reducir la tasa de bloqueos postoperatorios modificando la técnica de implante?

Abstract

IntroductionAortic valve replacement with sutureless prosthesis PercevalS is associated with an increase in the rate of postoperative atrioventricular block that requires permanent pacemaker implantation compared to conventional bioprostheses. In our series, we modified the implant technique (minimum ballooning <5seconds, rigorous annular decalcification, advancement of the folded prosthesis to the left ventricle outflow tract and repositioning by traction of guide sutures). ObjectivesTo analyze the impact of the modification in the Perceval implant technique on the postoperative atrioventricular block rate which requires permanent pacemaker implantation. Material and methods438 patients underwent aortic valve replacement with Perceval prosthesis, excluding those corresponding to the initial phase of the program (6months, n=14), concomitant mitral surgery (n=18) or tricuspid (n=11) and pre-surgical pacemaker carriers (n=11). Two comparison groups were established; standard group (October 2013-November 2016, n=209) with standard implant technique. Modified group (December 2016-November 2017, n=184) with modified implant technique. We analyzed permanent pacemaker implantation rates (6months follow-up) and variables of interest between groups. ResultsImplantation rate of permanent pacemaker, standard and modified group (10.05% vs. 4.35%, P=.031, respectively). Age, standard and modified group (mean 78.15±0.34 vs. mean 74.90±0.47, P<.01, respectively). EuroscoreII, standard and modified group (mean 3.76±0.24 vs. mean 3.00±0.25, P=.03, respectively). There were no other significant differences between variables of interest. ConclusionsModification of the Perceval implant technique has been associated with a statistically significant reduction in the postoperative atrioventricular block rate requiring implantation of permanent pacemaker.