Early pacemaker insertion after aortic valve replacement with Edwards Intuity sutureless valve versus standard bioprosthesis

Background In patients undergoing aortic valve replacement the occurrence of postoperative conduction disorders is a serious adverse event, which may prolong the duration of hospitalisation and require insertion of a pacemaker. Purpose To evaluate the rate of pacemaker insertion after implantation of an Intuity sutureless aortic valve compared to standard surgical bioprosthesis. Methods This retrospective, monocentric study included patients who underwent aortic valve replacement with an Intuity sutureless aortic valve or a standard bioprosthetic valve between June 4, 2014 and June 27, 2016. The main assessment criterion was the rate of postoperative pacemaker insertion. Secondary assessment criteria included the rate of de novo conduction disorders, the rate of atrial arrhythmia or paroxysmal conduction disorders, mortality and duration of hospitalisation. Results Ninety-three patients received an Intuity sutureless aortic valve (median age: 76 [71,80] years) and 176 were implanted with a standard biological aortic valve (median age: 73 [68,79] years; P = 0.007). The rate of postoperative pacemaker insertion, after adjustment, was 22.5% in the Intuity group and 5.7% in the standard aortic valve group (OR = 5.5 [95% CI: 1.37–34.54]; P = 0.036). The main indications for postoperative pacemaker insertion were complete atrioventricular block and de novo left bundle branch block (LBBB) with slowing of the infra-hisian conduction velocity. The rate of postoperative de novo bundle branch block was higher in patients implanted with an Intuity valve (OR = 6.25 [2.01–24.74]; P = 0.042). Conclusions Higher rates of pacemaker insertion and de novo bundle branch block were observed in patients implanted with an Intuity sutureless bioprosthesis compared to those who received a standard surgical aortic valve.