International Journal of Cardiovascular and Thoracic Surgery

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Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation

Received: 01 March 2020    Accepted: 03 August 2020    Published: 20 August 2020
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Abstract

In the last few years, a significant increase in the number of patients with aortic stenosis requiring surgical or transcatheter aortic replacement (SAVR) or (TAVR) has been observed due to the larger aging population. Conduction disturbances requiring permanent pace maker implantation (PPMI) has been observed after SAVR and TAVR. In fact the incidence of PPMI following SAVR reached 11 to 13% while it occurred in7 to 36% of patients undergoing TAVR. The majority of rhythm problems are secondary to a significant trauma to the conduction system. In order to decrease the incidence of PPMI in patients undergoing SAVR, we developed a modified technique of SAVR that we applied on a group of 63 patients (group B) and we compared the incidence of PPMI in this group to the one observed in a second group of 62 patients who underwent the classic SAVR (group A). It was significantly lower in group B (3.2% vs 14.5%). In conclusion, The low incidence of PPMI (3.2%) observed in the modified SAVR group encourages us to recommend this technique in all patients undergoing biological SAVR especially that this technique is simple to apply highly reproducible and reliable. However, further multicenter and larger studies will help confirm our findings.

DOI 10.11648/j.ijcts.20200603.12
Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 3, May 2020)
Page(s) 44-48
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Aortic Valve Replacement, New Technique, Incidence of Pace Maker Implantation

References
[1] Klapkowski A, Pawlaczyk R, Kempa M, Jagielak D et al. Complete atrioventricular block after isolated aortic valve replacement. Kardiol pol 2016; 74: 985-993.
[2] Matthews IG, Fazal IA, Bates M, Turley A. In patients undergoing aortic valve replacement, what factors predict the requirement for permanent pacemaker implantation?
[3] Hwang YM, Kim J, Lee HL, Kim M et al. Conduction disturbances after isolated surgical aortic valve replacement in degenerative aortic stenosis. The journal of Thoracic and cardiovascular surgery2017; 154: 1556-1566.
[4] Erdogan HB, Kayalar N, Ardal H, Omeruglu SN et al. Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement. J Card Surg 2006; 21: 211-215.
[5] Limomgelli G, Ducceschi V, D ‘Andrea A, Renzulli A, Sarrubi B, De Feo M, Cerasuolo F, Calabro R, Cotrufo M: Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience. Heart, 2003; 89: 901-904.
[6] Bagur R, Manazzoni JM, Dumont E, Doyle D et al: Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis. Heart 2011; 97: 1687-1694.
[7] Nardi P, Pellegrino A, Scafuri A, Bellos K et al. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, risk factors and surgical technical aspects. Journal of cardiovascular medicine 2010; 11: 14-19.
[8] Dawkins S, Hobson A, Kalra P, Tang A et al. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications and predictors. Ann thorac Surg 2008; 85: 108-112.
[9] Glauber M, Lio A, Miceli A. Sutureless technology for aortic valve replacement: Looking beyond crossclamp time. J Thorac Cardiovasc Surg. 2016; 151: 1637-1638.
[10] Yanagawa B, Cruz J, Boisvert L, Bonneau D. A simple modification to lower incidence of heart block with sutureless valve implantation. Eur Heart J. 2013; 34: 1894-1905.
[11] Kostopoulo A, Karyofillis P, Livanis E et al. Permanent pacing after transcatheter aortic valve implantation of a corevalve prosthesis as determined by electrocardiographic and electrophysiological predictors: a single-centre experience. Europace, 2016; 18: 131-137. doi: 10.1093/europace/euc137.
[12] Van der Boon R, Houthuizem P, Urena M et al. Trends I n the occurrence of new conduction abnormalities after transcatheter aortic valve implantation. Catheter Cardiovasc Intervent. 2015; 85: 144-152. doi: 10.1002/cod.25765.
[13] Onalan O, Crystal A, Lashevsky I, Khalameizer V et al. Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long term follow-up. Am J Cardiol 2008; 101: 203-208.
[14] Merin O, Dearini J, Hyberger L Schaff H et al. Indications, effectiveness and long –term pacing dependency after cardiac surgery. Am J Cardiol 1997; 80: 1309-1313.
[15] Toggweiler S, Kobza R. Pacemaker implantation after transcatheter aortic valve: Why is this still happenning? J Thorac Dis 2018; 10 (Suppl 30): 3614-3619. doi: 10.21037/jtd.2018.06.103.
Author Information
  • Cardiothoracic Anesthesia Department, Saint George Hospital Medical Center, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

  • Faculty of Pharmacy, Lebanese University, INSPECT, LB, Beirut, Lebanon

  • Cardiothoracic Anesthesia Department, Saint George Hospital Medical Center, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

  • Cardiothoracic Surgery Department, Saint George Hospital, Balamand University, Saint George University, Beirut, Lebanon

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    Nadine Kawkabani, Omar Boustros, Rita Farah, Roula Darwish, Moussa Abi Ghanem, et al. (2020). Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation. International Journal of Cardiovascular and Thoracic Surgery, 6(3), 44-48. https://doi.org/10.11648/j.ijcts.20200603.12

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    ACS Style

    Nadine Kawkabani; Omar Boustros; Rita Farah; Roula Darwish; Moussa Abi Ghanem, et al. Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(3), 44-48. doi: 10.11648/j.ijcts.20200603.12

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    AMA Style

    Nadine Kawkabani, Omar Boustros, Rita Farah, Roula Darwish, Moussa Abi Ghanem, et al. Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation. Int J Cardiovasc Thorac Surg. 2020;6(3):44-48. doi: 10.11648/j.ijcts.20200603.12

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  • @article{10.11648/j.ijcts.20200603.12,
      author = {Nadine Kawkabani and Omar Boustros and Rita Farah and Roula Darwish and Moussa Abi Ghanem and Hassan Souidan and Hiba Zeidh and Mohammad Hadi El Charif and Bassam Abou Khalil},
      title = {Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {6},
      number = {3},
      pages = {44-48},
      doi = {10.11648/j.ijcts.20200603.12},
      url = {https://doi.org/10.11648/j.ijcts.20200603.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ijcts.20200603.12},
      abstract = {In the last few years, a significant increase in the number of patients with aortic stenosis requiring surgical or transcatheter aortic replacement (SAVR) or (TAVR) has been observed due to the larger aging population. Conduction disturbances requiring permanent pace maker implantation (PPMI) has been observed after SAVR and TAVR. In fact the incidence of PPMI following SAVR reached 11 to 13% while it occurred in7 to 36% of patients undergoing TAVR. The majority of rhythm problems are secondary to a significant trauma to the conduction system. In order to decrease the incidence of PPMI in patients undergoing SAVR, we developed a modified technique of SAVR that we applied on a group of 63 patients (group B) and we compared the incidence of PPMI in this group to the one observed in a second group of 62 patients who underwent the classic SAVR (group A). It was significantly lower in group B (3.2% vs 14.5%). In conclusion, The low incidence of PPMI (3.2%) observed in the modified SAVR group encourages us to recommend this technique in all patients undergoing biological SAVR especially that this technique is simple to apply highly reproducible and reliable. However, further multicenter and larger studies will help confirm our findings.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Reproducible and Reliable Modified Technique of Surgical Aortic Valve Replacement That Decreases the Incidence of Permanent Pace Maker Implantation
    AU  - Nadine Kawkabani
    AU  - Omar Boustros
    AU  - Rita Farah
    AU  - Roula Darwish
    AU  - Moussa Abi Ghanem
    AU  - Hassan Souidan
    AU  - Hiba Zeidh
    AU  - Mohammad Hadi El Charif
    AU  - Bassam Abou Khalil
    Y1  - 2020/08/20
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcts.20200603.12
    DO  - 10.11648/j.ijcts.20200603.12
    T2  - International Journal of Cardiovascular and Thoracic Surgery
    JF  - International Journal of Cardiovascular and Thoracic Surgery
    JO  - International Journal of Cardiovascular and Thoracic Surgery
    SP  - 44
    EP  - 48
    PB  - Science Publishing Group
    SN  - 2575-4882
    UR  - https://doi.org/10.11648/j.ijcts.20200603.12
    AB  - In the last few years, a significant increase in the number of patients with aortic stenosis requiring surgical or transcatheter aortic replacement (SAVR) or (TAVR) has been observed due to the larger aging population. Conduction disturbances requiring permanent pace maker implantation (PPMI) has been observed after SAVR and TAVR. In fact the incidence of PPMI following SAVR reached 11 to 13% while it occurred in7 to 36% of patients undergoing TAVR. The majority of rhythm problems are secondary to a significant trauma to the conduction system. In order to decrease the incidence of PPMI in patients undergoing SAVR, we developed a modified technique of SAVR that we applied on a group of 63 patients (group B) and we compared the incidence of PPMI in this group to the one observed in a second group of 62 patients who underwent the classic SAVR (group A). It was significantly lower in group B (3.2% vs 14.5%). In conclusion, The low incidence of PPMI (3.2%) observed in the modified SAVR group encourages us to recommend this technique in all patients undergoing biological SAVR especially that this technique is simple to apply highly reproducible and reliable. However, further multicenter and larger studies will help confirm our findings.
    VL  - 6
    IS  - 3
    ER  - 

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