초록접수 현황
| 20F-161 | 구연 발표 |
Impact of Modified Suture Technique for Prevention of Permanent Pacemaker Implantation after Perceval Sutureless Aortic Valve Replacement
Do Jung Kim1, Sak Lee2, Hyun-Chel Joo2, Young-Nam Youn2, Kyung-Jong Yoo2, and Seung Hyun Lee2
1 Department of Thoracic and Cardiovascular Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Republic of Korea.
2 Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Purpose : The self-expandable Perceval valves are potentially damaged the atrioventricular conduction tissue, which can result in a high incidence of pacemaker implantation (PMI). Recently, various surgical tips have been reported to avoid the conduction disturbance. This study was conducted to compare the incidence of PMI according to the depth of guiding sutures.
Methods : From December 2014 to July 2020, 176 consecutive patients underwent sutureless aortic valve replacement (Su-AVR) with the Perceval valve. Since July 2018, we have implemented the placing the guiding sutures no more than 2 mm below the nadir of the annulus. The population was divided into 2 groups: before (Group 1, n=87) and after (Group 2, n=89) modification of placing the guiding sutures.
Results : The study groups showed similar distribution of implanted valve size (S; 24.1% vs. 28.1%, M; 32.2% vs. 37.1%, L; 26.4% vs. 23.6%, XL; 17.2% vs. 11.2%, all P >0.05). No significant differences were found in aortic cross-clamping and cardiopulmonary bypass time for isolated and combined procedures. Permanent PMI after Su-AVR was required in 9 patients postoperatively (5.7%) because of third-degree atrioventricular block. The incidence of PMI was significantly higher in the group 1 compared with group 2 (9.2% vs. 2.2%, P=0.047). No patient had developed moderate or severe aortic regurgitation, valve thrombosis, or endocarditis.
Conclusion : The use of Perceval valves provided excellent early clinical outcomes. Despite the high rate of PMI after Perceval valve implantation, our results showed that the modified suture technique may play an important role in preventing conduction disorders.
Methods : From December 2014 to July 2020, 176 consecutive patients underwent sutureless aortic valve replacement (Su-AVR) with the Perceval valve. Since July 2018, we have implemented the placing the guiding sutures no more than 2 mm below the nadir of the annulus. The population was divided into 2 groups: before (Group 1, n=87) and after (Group 2, n=89) modification of placing the guiding sutures.
Results : The study groups showed similar distribution of implanted valve size (S; 24.1% vs. 28.1%, M; 32.2% vs. 37.1%, L; 26.4% vs. 23.6%, XL; 17.2% vs. 11.2%, all P >0.05). No significant differences were found in aortic cross-clamping and cardiopulmonary bypass time for isolated and combined procedures. Permanent PMI after Su-AVR was required in 9 patients postoperatively (5.7%) because of third-degree atrioventricular block. The incidence of PMI was significantly higher in the group 1 compared with group 2 (9.2% vs. 2.2%, P=0.047). No patient had developed moderate or severe aortic regurgitation, valve thrombosis, or endocarditis.
Conclusion : The use of Perceval valves provided excellent early clinical outcomes. Despite the high rate of PMI after Perceval valve implantation, our results showed that the modified suture technique may play an important role in preventing conduction disorders.
책임저자: Seung Hyun Lee
Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Do Jung Kim, E-mail : DJkim119@aumc.ac.kr