Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR

Degenerative aortic valve stenosis is the most frequent valvular heart disease in western countries, and valve replacement is the gold standard for symptomatic severe cases. In addition to the two established procedures (surgical aortic valve replacement [SAVR] and transcatheter aortic valve implantation [TAVI]), the last decade showed the rising of a third way, which is based on the concept of the surgical replacement but takes some advantages of the TAVI prosthesis's design, such as the faster and simpler anchoring mechanism. This category includes the interventions performed with the sutureless and the rapid deployment prostheses. Sutureless and rapid-deployment (SURD-AVR) has been applied to high- and intermediate-risk populations with good clinical results. However, concerns were raised because of the incidence of postprocedural permanent pacemaker implantation (PPI), which was higher than in conventional SAVR and similar to that observed following TAVI. Possible factors associated with this complication have been assessed only in single-center studies with small sample populations. Moreover, recent analyses reported a reduction of this complication over time, suggesting the possible role of a time bias or learning curve effect. For these reasons, the authors aimed to investigate the need for PPI following SURD-AVR in a large cohort using a progress report approach.