Risk Factors for Postoperative Pacemaker Implantation after Rapid Deployment Aortic Valve Replacement: Results from the Radar Registry

Objectives: Rapid deployment aortic valve replacement has been recently introduced in clinical practice. Different studies have reported a significant reduction in surgical times with excellent hemodynamic profile and short-term results. However, an increase in permanent pacemaker requirements when compared with conventional aortic valve replacement has been described. Nevertheless, risk factors for postoperative pacemaker implantation are not well known.

Methods: Between April 2012 and January 2016, a total of 164 patients undergoing isolated or combined aortic valve replacement with a rapid deployment valve were included in the RADAR Registry. Pre-, intra-, and postoperative clinical data results and complications were recorded, especially focusing on risk factors for the development of postoperative complete or high-grade AV block requiring pacemaker implantation. Patients were followed-up for up to 1 year.

Result: A total of 164 consecutive patients were included in this study, where 128 patients (78.05%) had an isolated aortic valve replacement (group 1) and 36 (21.95%) a concomitant procedure (group 2). Surgical approach was ministernotomy in 61 patients (37.20%) and median sternotomy in 100 patients (60.98%). Complications with valve implantation were observed in 3 patients. Postoperative complete or high-degree AV block requiring a permanent pacemaker implantation developed in 6.9%. 7 patients died in-hospital (4.27%). No significant differences between groups were found in terms of stroke, postoperative infection, mortality, atrial fibrillation and postoperative atrioventricular block. 7 patients presented acute renal impairment (5.51%) in group 1 vs. 7 patients (20%) in group 2 (p = 0.007). In multivariate analysis, low weight, preoperative arrhythmias (atrial fibrillation, bifascicular block, and left bundle branch block) emerged as risk factors for postoperative AV block requiring a pacer. For a median follow-up for 1 year, 7 (4.27%) patients died, no cases or structural valve deterioration or endocarditis were observed.

Conclusion: Initial experience with rapid deployment aortic valve replacement demonstrates low rates of implantation complications, good perioperative and 1 year outcomes. Incidence of postoperative AV block requiring a pacer correlated with low weight and preoperative arrhythmias. Avoidance of oversizing and careful consideration of implantation of this technology in patients with preexisting arrhythmias could minimize the risk for postoperative pacemaker implantation.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021