A Myth Busted—Sutureless Rapid Deployment Valves Do not Have Increased Pacemaker Rates

Background: The sutureless rapid deployment valves (RDV) Corcym Perceval and Perceval Plus presumably are associated with higher rates of permanent pacemaker implantation (PPI) due to the effect of radial forces on the conduction system. This study evaluates the correlation of PPI and sutureless valves in a large cohort.

Methods: A consecutive series of 1,184 RDV implantations between 2014 and 2023 was included and divided in three consecutive sections: (I) “Perceval with old sizing chart” (n = 229), (II) “Perceval with new sizing chart” (n = 386), and (III) 2nd-generation Perceval Plus (n = 569). Patients with pre-existing pacemakers were excluded. Valve size, pre- and postoperative ECG, and length of the membranous ventricular septum (mVS) were analyzed. Endpoint was permanent pacemaker implantation (PPI). A consecutive series of 200 sutured valves served as reference for sutured PPI rate.

Results: Overall PPI rate was 6.8%, not differing significantly from the sutured control (6.5%; p = 0.81). PPI rates differed significantly between the defined sections: “Perceval with old sizing chart” 7.9%, “Perceval with new sizing chart” 9.0%, “2nd-generation Perceval Plus” 4.8% (p < 0.001). Overall size-related PPI rates for the 1st-generation Perceval were S = 5.5%, M = 3.8%, L = 10.0% and XL = 14.3% (p = 0.044) and PPI rates for the 2nd-generation Perceval Plus were S = 3.1%, M = 2.8%, L = 5.4% and XL = 7.8% (p = n.s.). Mean length of the mVS was 10.0 ± 3.1 mm and a length <9.2 mm was predictive for PPI (ROC analysis; AUC = 0.73; p = 0.004). Multivariate regression identified mVS length (p < 0.001), pre-existing RBB (p = 0.049), and valve size (p = 0.01) as independent predictors of PPI.

Conclusion: Overall PPI rate of sutureless RDVs was not significantly different compared with sutured valves. The changed design with a reduced ventricular protrusion of the 2nd-generation SelfEX-RDV resulted in significantly less PPI. Generally, the combination of larger valve sizes and shorter membranous septum lengths was associated with increased PPI. Therefore, main pathomechanism rather seems to be the subannular protrusion than radial forces.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025