Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement

Objective: Atrioventricular (AV) conduction impairment represents an infreq uent complication following aortic valve replacement (AVR). Although severa l conditions have been considered as potential risk factors for such a post operative event, the role of the surgical technique has not been evaluated. The aim of this study was to investigate if the suture technique for impla ntation of the prosthetic valve is a potential risk factor need of pacemake r (PM) implantation after AVR. Methods: One hundred twenty-four patients un dergoing AVR were enrolled in this study. A "continuous" suture technique w as performed in 72 patients (58%; Group A), whereas an "interrupted" suture technique was used in 52 patients (42%; Group 13). The incidence of "major ," requiring PM implantation, as well as "minor," without PM implantation, impairment of the AV conduction was evaluated and compared in the two group s by means of univariate and multivariate analyses. Results: The patients o f the two groups were homogenous for all preoperative parameters except pat ient age. A longer clamp time was present in the patients of group B than t hose of group A (73 +/- 24 minutes and 60 +/- 24 minutes, respectively; p < 0.01). Postoperatively, hospital mortality consisted of four patients (3.2 %) with no statistical importance between the two groups. Eleven patients o f group A (17.5%) and one patient of group B (2.2%) required PM implantatio n (p < 0.05). Prolonged P-R interval was recorded in 15 patients of group A and in 5 patients of group B (p < 0.05). Conclusions: We showed that the c ontinuous suture technique increases the need for postoperative PM implanta tion after AVR. No major differences have been observed, however, regarding in-hospital mortality and length of hospital stay, regardless of the type of prosthetic suture technique.