A simple modification to lower incidence of heart block with sutureless valve implantation  Bobby Yanagawa, MD, PhD, Jorge Cruz, MD, Lyna Boisvert, RN,

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A simple modification to lower incidence of heart block with sutureless valve implantation  Bobby Yanagawa, MD, PhD, Jorge Cruz, MD, Lyna Boisvert, RN, CV-ICU, BScN, Daniel Bonneau, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 152, Issue 2, Pages 630-632 (August 2016) DOI: 10.1016/j.jtcvs.2016.02.034 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Top: Image of the Perceval sutureless valve (courtesy of LivaNova, Milan, Italy) and the width from the eyelet to the sealing collar edge (insert, between arrows). Middle: Transesophageal echocardiographic image showing the distance from the annulus to the lower edge of the sealing collar (between arrows): 4 mm in a patient without PPM (left) and 10 mm in a patient with PPM for heart block (right). Bottom: Distance from annulus to lower edge of sealing collar for all patients. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 630-632DOI: (10.1016/j.jtcvs.2016.02.034) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Low valve implantation with respect to the annulus (between arrows) and need for pacemaker. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 630-632DOI: (10.1016/j.jtcvs.2016.02.034) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions