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Modified annular suturing technique for minimizing postoperative pacemaker use after surgical aortic valve replacement

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Abstract

Objective

Although low postoperative pacemaker implantation rate is one of the advantages of surgical aortic valve replacement over transcatheter aortic valve replacement, there is still room for improvement. We invented a new modified suturing technique avoiding proximity to the conduction system and assessed the effectiveness and safety of the suturing technique.

Methods

We reviewed 257 patients undergoing surgical aortic valve replacement between October 2013 and August 2019. The modified suturing technique was used in 83 patients (group A) and standard technique (non-everting mattress, simple interrupted or continuous running technique) was used in 174 patients (group B). We compared the incidences of conduction disturbances between two groups. We also compared them in the subgroup of isolated surgical aortic valve replacement cases (n = 159).

Results

The incidences of new left bundle branch block were 0% in group A and 6.6% in group B (p = 0.02), those of new 2nd/3rd degree atrioventricular block were 0% in group A and 5.2% in group B (p = 0.03). The incidences of postoperative temporary pacing use were 2.4% in group A and 12.6% in group B (p < 0.01). The incidences of 30-day new permanent pacemaker implantation were 0% in group A and 1.1% in group B (p = 1.00). In the subgroup analysis, postoperative temporary pacing was used less frequently in the modified suturing technique group (p = 0.01).

Conclusion

Our modified suturing technique reduced postoperative temporary pacemaker use after surgical aortic replacement and may enhance the advantage of surgical aortic valve replacement over transcatheter aortic valve replacement.

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References

  1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98.

    Article  CAS  Google Scholar 

  2. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J Jr, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK, U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–8.

    Article  CAS  Google Scholar 

  3. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.

    Article  CAS  Google Scholar 

  4. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP, SURTAVI Investigators. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321–31.

    Article  Google Scholar 

  5. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL 3rd, Forrest JK, Tchétché D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ, Evolut Low Risk Trial Investigators. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019;380(18):1706–15.

    Article  Google Scholar 

  6. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR, PARTNER 3 Investigators. Transcatheter aortic-valve replacement with balloon-expandable valve in low-riskpatients. N Engl J Med. 2019;380(18):1695–705.

    Article  Google Scholar 

  7. Greason KL, Lahr BD, Stulak JM, Cha YM, Rea RF, Schaff HV, Dearani JA. Long-term mortality effect of early pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg. 2017;104:1259–66.

    Article  Google Scholar 

  8. Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK. Aortic Valve Disease. In: Lampert RH, editor. Kirklin/barratt-boyes cardiac surgery, vol. 1. 4th ed. Philadelphia: Saunders; 2012. p. 560.

    Google Scholar 

  9. Gardner TJ, Spray TL. Aortic valve replacement. In: Joanna K, editor. Operative cardiac surgery. 5th ed., Rob & Smith’s Operative Surgery SeriesLondon: Arnold; 2004. p. 240.

    Chapter  Google Scholar 

  10. Khonsari S, Sintek CF. Surgery of the Aortic Valve. In: McAllister L, editor. Cardiac surgery: safeguards and pitfalls in operative technique. 3rd ed. Philadelphia: LWW; 2003. p. 57.

    Google Scholar 

  11. Ulrich PS, Berli J, Berdajs D, Haeusler A, Dzemali O, Emmert M, Seifert B, Genoni M. Incidence and risk factors for pacemaker implantation following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2010;11:556–60.

    Article  Google Scholar 

  12. Moskowitz G, Hong KM, Giustino G, Gillinov AM, Ailawadi G, DeRose JJ, Iribarne A, Moskowits AJ, Gelijns AC, Egorova NN. Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery. J Am Coll Cardiol. 2019;74:2607–20.

    Article  Google Scholar 

  13. Bagur R, Manazzoni JM, Dumont E, Doyle D, Perron J, Dagenais F, Mathieu P, Baillot R, Charbonneau E, Metrās J, Mohammadi S, Cōte M, Philippon F, Voisine P, Rodēs-Cabau J. Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis. Heart. 2011;97:1687–94.

    Article  Google Scholar 

  14. Tabata M, Shibayama K, Watanabe H, Sato Y, Fukui T, Takanashi S (2014) Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis. J Thorac Cardiovasc Surg 147(1):321–325

    Article  Google Scholar 

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There was no financial funding for this study.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-shi, Chiba, Japan

    Hiromi Yanagisawa & Minoru Tabata

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  1. Hiromi Yanagisawa
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  2. Minoru Tabata
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Correspondence to Minoru Tabata.

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Yanagisawa, H., Tabata, M. Modified annular suturing technique for minimizing postoperative pacemaker use after surgical aortic valve replacement. Gen Thorac Cardiovasc Surg 69, 254–259 (2021). https://doi.org/10.1007/s11748-020-01450-y

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  • DOI: https://doi.org/10.1007/s11748-020-01450-y

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