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. 2022 Jul 9;35(2):ivac182.
doi: 10.1093/icvts/ivac182.

Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant

Olivier Fabre  1 , Mihai Radutoiu  1 , Ionut Carjaliu  1 , Olivier Rebet  1 , Laurence Gautier  1 , Ilir Hysi  1
Affiliations

Recent improvement in operative techniques lead to lower pacemaker rate after Perceval implant

Olivier Fabre et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: Our goal was to compare pacemaker rate usage following two different operating techniques for implanting the Perceval aortic valve replacement.

Methods: In this retrospective, single-centre study, we studied patients with isolated or concomitant Perceval aortic valve replacement operated on first between April 2013 and January 2016, following traditional operating techniques, with patients operated on between January 2016 and December 2020, after the adoption of a modified protocol based on different annulus sizing, higher positioning of the valve and no ballooning after valve deployment was adopted. The operations were performed by 2 surgeons, and patients were followed-up for a period of 30 days.

Results: A total of 286 patients, with a mean age of 77 (4.9) years, had Perceval valves implanted during the study period, of which 79% were isolated aortic valve procedures. Most patients (66.8%) underwent minimally invasive procedures. Cross-clamp time was 55.1 (17.6) min. The overall postoperative pacemaker insertion rate was 8.4%, which decreased decisively after the 2016 change in the implant protocol (16% vs 5.6%; P = 0.005), adjusted odds ratio of 0.31 (95% confidence interval: 0.13-0.74, P = 0.012). Univariable and multivariable analysis showed that larger valve size (P = 0.01) and ballooning (P = 0.002) were associated with higher risk of implanting a pacemaker. Postoperative 30-day mortality was of 4.5%.

Conclusions: Improvement in the operating techniques for implanting the Perceval valve may decrease the rate of pacemakers implanted postoperatively. Although further studies are needed to confirm these results, such a risk reduction may lead to wider use of Perceval valves in the future, potentially benefiting patients who are suitable candidates for minimally invasive surgery.

Keywords: Aortic valve replacement; Minimally invasive; Pacemaker rate; Perceval.

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Figures

Central picture.
Central picture.
Decrease in the pacemaker rate after Perceval implants in the last 5 years. The left Y-axis shows the percent of permanent cardiac pacemakers implanted. The right Y-axis (in green) shows the number of Perceval valves implanted.
Figure 1:
Figure 1:
The outer diameter of the obturator (sizer) of the Perceval is always smaller than the inner diameter of the related valve.
Figure 2:
Figure 2:
Distribution of the pacemakers according to the size of the valve. Results are presented as bars (absolute numbers) and as percentage of the different sizes of the valves implanted. L: large; M: medium; Nr: number; PCM: permanent cardiac pacemaker; S: small; XL: extra large.
Figure 3:
Figure 3:
Photograph of a medium-sized and an extra-large-sized Perceval valve. The red lines clearly show that the inflow portion of the stent of the valve is higher in the extra large valve. M: medium; EL: extralarge.
Figure 4:
Figure 4:
Distances measured of the inflow portion of the stent of the Perceval valve according to the size of the valve (courtesy of CORCYM, previously LivaNova). L: large; M: medium; S: small; XL: extra large.
See this image and copyright information in PMC

Comment in

  • The importance of sizing in sutureless valves.
    Meuris B, Lamberigts M, Szecel D. Meuris B, et al. Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3):ivac206. doi: 10.1093/icvts/ivac206. Interact Cardiovasc Thorac Surg. 2022. PMID: 35924972 Free PMC article. No abstract available.

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