Permanent pacemaker implantation after sutureless aortic valve replacement with the perceval valve: predictors and clinical implications.

OBJECTIVES: Permanent pacemaker implantation (PPI) remains a concern after sutureless aortic valve replacement (S-AVR) with the Perceval valve. This study aimed to identify preoperative predictors of PPI and evaluate its impact on mid-term survival in a large single-center cohort. METHODS: We retrospectively analyzed 334 patients who underwent S-AVR using the Perceval valve between January 2017 and December 2023. Patients were stratified according to the occurrence of postoperative PPI. Independent predictors of PPI were identified using multivariable logistic regression. Overall survival was assessed using Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS: PPI occurred in 21 patients (6.2%). Preoperative right bundle branch block (RBBB) was significantly more prevalent among patients requiring PPI (66.7% vs. 11.2%, P < 0.001). In multivariable logistic regression analysis, preoperative RBBB (Odds ratio [OR] 44.42; P < 0.001), hypertension, and QRS duration (per 10-ms increase) were independently associated with PPI. The association between RBBB and PPI remained significant in Firth penalized logistic regression analysis (OR, 32.77; P < 0.001). CONCLUSIONS: Preoperative RBBB is independently associated with PPI after Perceval S-AVR and demonstrated the strongest observed association among the evaluated variables. Careful preoperative risk stratification and postoperative rhythm surveillance may help identify patients at increased risk for conduction-related complications.