Two-year incidence of PPMI post SAVR, modified SAVR and TAVR

Abstract

Abstract Background Moderate and high risk patients presenting with aortic stenosis are offered surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating permanent pace maker implantation (PPMI). Many factors have been implicated in increasing the risk of atrioventricular (AV) block and subsequent PPMI. The stress on the conduction system seems to be a major cause of this complication. Methods We conducted a study to compare the incidence of PPMI between two groups of patients. In group A, 62 patients underwent the classic SAVR and in group B, 92 patients underwent a simple modified SAVR technique (3–4 pledgeted ethibond sutures were placed above the annulus, at the commissure between the right and non coronary sinuses) that aims to decrease the mechanical trauma to the conduction system. Results The results revealed a significant lower PPMI rate in group B as compared to group A,at thirty days (2.17% versus 14.5%) as well as at two years (2.17% versus 17.7%) postoperatively. The statistical analysis showed that the operative technique was a strong predictor of the need for PPMI. The odds of needing pace maker implantation was significantly lower in the group of patients who underwent the simple modified SAVR technique. Of note is that the reported incidence of PPMI in the literature, at thirty days and two- years post classic SAVR were 6.1% and 11%. In addition, the rate observed in group B, was lower than the post-TAVR incidence of PPMI (9.3% at thirty days and 13% at two years post procedure), as reported by numerous studies, whether self expandable or balloon expandable valves were used. Conclusion This reproducible and reliable simple technique should be recommended whenever SAVR is performed.On the other hand,the low incidence of PPMI (2.17%) observed after a modified SAVR technique should be adopted as a benchmark whenever TAVR is offered as a therapeutic option. Moreover, this less traumatic procedure may be taken into consideration whenever stent design modifications for TAVR are considered. Funding Acknowledgement Type of funding sources: None.