Pollari Francesco, Berretta Paolo, Albertini Alberto, Carrel Thierry, Teoh Kevin, Meuris Bart, Villa Emmanuel, Kappert Utz, Andreas Martin, Solinas Marco, Misfeld Martin, Savini Carlo, Fiore Antonio, Shrestha Malakh, Santarpino Giuseppe, Martinelli Gian Luca, Mignosa Carmelo, Glauber Mattia, Yan Tristan, Fischlein Theodor, Di Eusanio Marco
Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
Thorac Cardiovasc Surg. 2023 Oct;71(7):557-565. doi: 10.1055/s-0042-1757778. Epub 2022 Oct 18.
The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR).
We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group ("EG" = 2008-2016) and a late group ("LG" = 2017-2019).
The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of associated procedures, and more frequent use of smaller prostheses were observed over time. In the RD cohort, the rate of PPI was stable over time (EG = 8.8% vs LG = 9.3%, = 0.8). In this cohort, a younger age, lower risk profile, and higher incidence of concomitant septal myectomy were observed over time.
Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.
本研究旨在根据一项大型多中心国际注册研究（SURD-IR）的进展报告，调查无缝合快速植入主动脉瓣置换术（SuRD-AVR）后永久性起搏器植入（PPI）的必要性。
我们回顾性分析了2008年至2019年间接受SuRD-AVR的4166例患者。主要结局是出院前是否需要植入PPI。根据植入的假体将研究人群分别进行分析（Su队列和RD队列）。每个队列根据手术日期分为两组：早期组（“EG”=2008-2016年）和晚期组（“LG”=2017-2019年）。
Su队列中PPI发生率随时间显著下降（早期组为10.8%，晚期组为6.3%，<0.001）。在Su队列中，随着时间的推移，年龄、风险状况和二叶式主动脉瓣发生率降低，右前外侧开胸手术的使用增加，体外循环时间和相关手术减少，且更频繁地使用较小尺寸的假体。在RD队列中，PPI发生率随时间保持稳定（早期组为8.8%，晚期组为9.3%，=0.8）。在该队列中，随着时间的推移，年龄较轻、风险状况较低以及同期室间隔心肌切除术的发生率较高。
我们的分析表明，接受Su-AVR的患者PPI发生率随时间显著下降。患者选择、手术改进以及更精确的尺寸选择可能与这一现象相关。RD队列在两个时间段的患者特征或PPI发生率方面均未显示出显著差异。
