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

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.