Novel Aortic Valve Replacement Technique for Reducing Complete Heart Block

Neda Roshanravan; Faezeh Tarighat; Sara Pahlavan; Mahdi Parvizi; Erfan Banisefid; Somayeh Abolhasani; Amir Hadi; Rezayat Parvizi

doi:10.18502/jthc.v18i3.14112

Neda Roshanravan Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Faezeh Tarighat Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Sara Pahlavan Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
Mahdi Parvizi Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Erfan Banisefid Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
Somayeh Abolhasani Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
Amir Hadi Halal Research Center of IRI, Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran.
Rezayat Parvizi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

DOI: https://doi.org/10.18502/jthc.v18i3.14112

Keywords: Aortic valve; Replacement; Pacemaker; Heart block

Abstract

Background: Aortic valve replacement (AVR) may complicate conduction abnormalities and require permanent pacemaker (PPM) implantation. New techniques that lessen this challenge may lead to the development of new approaches. Our objective was to evaluate the contemporary incidence of early postoperative PPM implantation in patients undergoing isolated AVR and root disease with the standard AVR surgical technique compared with the novel suture AVR technique.

Methods: The clinical data of 354 patients (250 male, 104 female) who underwent surgery for isolated AVR and root disease in different referral cardiology departments in Tabriz, Iran, over 4 years were analyzed. Patients with preoperative significant conduction abnormalities were excluded from the study. The patients were evaluated for in-hospital mortality, postoperative PPM implantation, and their stay in the ICU after surgery.

Results: The mean age of the patients was 52.46±16.13 years. Totally, 183 patients (51.7%) were operated on with the new suture AVR technique. In-hospital mortality was lower in this group than in the group that underwent the “classic” surgical technique (2.5% vs 3.7%). PPM implantation was required in 3 patients (0.8%) after the novel suture AVR technique, whereas it was needed in 12 patients (3.4%) in the other group (P=0.024). The mortality rate was 9 patients (2.5%) in group 1 and 13 patients (3.7%) in group 2, which was not statistically significant (P=0.296). According to the logistic regression, the survival rate in the group operated on with the classical surgical method was 0.27 times higher than that in the patients operated on with the new method.

Conclusion: Permanent complete AV block is a critical complication after AVR surgery. A lower PPM requirement and higher survival in patients operated on with the new method was the main finding of this study. New techniques with lower PPM requirements may be suitable for cardiac surgery.