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Farina J, Biffi M, Folesani G, Di Marco L, Martin S, Zenesini C, Savini C, Ziacchi M, Diemberger I, Martignani C, Pacini D. Long-Term Atrioventricular Block Following Valve Surgery: Electrocardiographic and Surgical Predictors. J Clin Med 2024; 13:538. [PMID: 38256672 PMCID: PMC10816093 DOI: 10.3390/jcm13020538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. METHODS We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010. RESULTS During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2-3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9-12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4-10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8-8.3, p < 0.001). CONCLUSION Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation.
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Affiliation(s)
- Jacopo Farina
- Cardiology Unit, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Mauro Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.B.); (M.Z.); (I.D.); (C.M.)
| | - Gianluca Folesani
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.F.); (L.D.M.); (S.M.); (C.S.); (D.P.)
| | - Luca Di Marco
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.F.); (L.D.M.); (S.M.); (C.S.); (D.P.)
| | - Sofia Martin
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.F.); (L.D.M.); (S.M.); (C.S.); (D.P.)
| | - Corrado Zenesini
- Epidemiology and Statistic Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Carlo Savini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.F.); (L.D.M.); (S.M.); (C.S.); (D.P.)
| | - Matteo Ziacchi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.B.); (M.Z.); (I.D.); (C.M.)
| | - Igor Diemberger
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.B.); (M.Z.); (I.D.); (C.M.)
| | - Cristian Martignani
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.B.); (M.Z.); (I.D.); (C.M.)
| | - Davide Pacini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.F.); (L.D.M.); (S.M.); (C.S.); (D.P.)
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El Diasty M, Davies M, Fernandez AL, Ribeiro I, Payne D, Petsikas D. Does Pacemaker Implantation After Surgical Aortic Valve Replacement Impact Long-Term Morbidity and Mortality? A Focused Review. Tex Heart Inst J 2022; 49:487617. [PMID: 36252278 PMCID: PMC9632401 DOI: 10.14503/thij-20-7518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Permanent pacing remains a serious complication that can occur in the postoperative period of surgical aortic valve replacement. The reported incidence is variable, and there are many perioperative factors that have been linked with a greater need for permanent pacing. Permanent pacing can also be associated with late lead-related and cardiac complications that can affect late outcome. However, the degree of late dependence on pacemakers is varied, and some studies have shown that a substantial proportion of patients do not need long-term pacing. Some groups have found that permanent pacing was associated with a negative impact on long-term survival in these patients. A common finding among these studies is that the groups of patients with pacemakers had higher preoperative surgical risk and comorbidity status. This makes it difficult to establish whether permanent pacing on its own represents a risk factor for late mortality or whether it is simply a marker that reflects the higher complexity and comorbidities in this group of patients.
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Affiliation(s)
- Mohammad El Diasty
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Mark Davies
- Cardiology Department, Oxford University Hospital, Oxford, United Kingdom
| | - Angel L. Fernandez
- Cardiovascular Surgery Department, University Hospital, Santiago de Compostela, Spain
| | - Igo Ribeiro
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Darrin Payne
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Dimitri Petsikas
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
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Impact of Atrial Fibrillation on Outcomes of Aortic Valve Implantation. Am J Cardiol 2022; 163:50-57. [PMID: 34772477 DOI: 10.1016/j.amjcard.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022]
Abstract
New or preexisting atrial fibrillation (AF) is frequent in patients undergoing aortic valve replacement. We evaluated whether the presence of AF during transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) impacts the length of stay, healthcare adjusted costs, and inpatient mortality. The median length of stay in the patients with AF increased by 33.3% as compared with those without AF undergoing TAVI and SAVR (5 [3 to 8] days vs 3 [2 to 6] days, p <0.0001 and 8 [6 to 12] days vs 6 [5 to 10] days, p <0.0001, respectively). AF increased the median value of adjusted healthcare associated costs of both TAVI ($46,754 [36,613 to 59,442] vs $49,960 [38,932 to 64,201], p <0.0001) and SAVR ($40,948 [31,762 to 55,854] vs $45,683 [35,154 to 63,026], p <0.0001). The presence of AF did not independently increase the in-hospital mortality. In conclusion, in patients undergoing SAVR or TAVI, AF significantly increased the length of stay and adjusted healthcare adjusted costs but did not independently increase the in-hospital mortality.
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Reduced Permanent Pacemaker Implantation in Patients With Stentless Freedom SOLO Compared With Stented Perimount Magna Aortic Bioprostheses: A Propensity Score Weighted Analysis. Heart Lung Circ 2020; 30:423-430. [PMID: 32800443 DOI: 10.1016/j.hlc.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Postoperative permanent pacemaker implantation (PPI) after conventional aortic valve replacement (AVR), due to new-onset severe conduction system disorders, is required in approximately 7% of patients. This study investigated the need for PPI after AVR with conventional stented Perimount Magna compared with the Freedom SOLO (FS) stentless valve (Sorin Group, Saluggia, Italy), now LivaNova plc (London, UK) that uses a strictly supra-annular, subcoronary running suture implantation technique, sparing the vulnerable interleaflet triangles in the region of the septum membranaceum. METHODS A total of 413 consecutive patients (71.4±9.2 yrs, 178 [43.1%] female) underwent isolated AVR using the stented Perimount Magna (n=264) or the stentless FS (n=149) bioprosthesis. Propensity score weighted analysis was used to account for patient-specific and procedural-specific variables, and to identify the prosthesis-specific need for early postoperative PPI within 30 days of AVR. RESULTS Twenty (20) patients required PPI, which was associated with longer intensive care unit (2.1±1.7 vs 1.5±3.0 days, p<0.001) and overall hospital stays (13.8±5.2 vs 10.7±5.3 days, p<0.001) compared with no PPI. Propensity weighted logistic regression including cross-clamp times identified that use of the stented Perimount Magna was associated with increased need for PPI, as compared with the FS, with an odds ratio 5.8 (95% CI, 1.09-30.76; p=0.039). CONCLUSIONS After corrections for all plausible confounders, AVR with the stented Perimount valve was associated with an odds ratio of almost 6 for an increased early postoperative need for pacemaker implantation compared with the FS stentless valve. This finding can be explained by the conventional implantation technique, which is potentially associated with mechanical trauma to the conducting system.
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Viktorsson SA, Orrason AW, Vidisson KO, Gunnarsdottir AG, Johnsen A, Helgason D, Arnar DO, Geirsson A, Gudbjartsson T. Immediate and long-term need for permanent cardiac pacing following aortic valve replacement. SCAND CARDIOVASC J 2019; 54:186-191. [PMID: 31809597 DOI: 10.1080/14017431.2019.1698761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Atrioventricular (AV) node conduction disturbances are common following surgical aortic valve replacement (SAVR), and in some cases the patient needs a permanent pacemaker (PPM) implantation before discharge from hospital. Little is known about the long-term need for PPM and the PPM dependency of these individuals. We determined the incidence of PPM implantation before and after discharge in SAVR patients. Methods: We studied 557 consecutive patients who underwent SAVR for aortic stenosis in Iceland between 2002 and 2016. Timing and indication for PPM were registered, with a new concept, ventricular pacing proportion (VPP), defined as ventricular pacing ≥90% of the time, being used to approximate pacemaker dependency. The median follow-up time was 73 months. We plotted the cumulative incidence of pacemaker implantation, treating death as a competing risk. Results: Of the 557 patients, 22 (3.9%) received PPM in the first 30 days after surgery, most commonly for complete AV block (n = 14) or symptomatic bradycardia (n = 8); Thirty-eight other patients (6.8%) had a PPM implanted >30 days postoperatively, at a median of 43 months after surgery (range 0‒181), most often for AV block (n = 13) or sick-sinus syndrome (n = 10). The cumulative incidence of PPM implantation at 1, 5, and 10 years postoperatively was 5.0%, 9.2%, and 12.3%, respectively. During follow-up, 45.0% of the 60 patients had VPP ≥90%. Conclusion: The cumulative incidence of permanent pacemaker implantation following SAVR was about 12% at 10 years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.
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Affiliation(s)
- Sindri A Viktorsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andri W Orrason
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristjan O Vidisson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna G Gunnarsdottir
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arni Johnsen
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Dadi Helgason
- Internal Medicine Services, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - David O Arnar
- Division of Cardiology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Arribas JM, Soriano L, Rivera-Caravaca JM, Lorenzo M, Muñoz C, Taboada R, Jiménez A, Martínez J, García-Puente J, Gutiérrez F, Manzano S, Cánovas S. Incidence and causes of pacemaker implantation during postoperative period of aortic valve replacement with rapid deployment prosthesis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1534-1540. [PMID: 31677175 DOI: 10.1111/pace.13824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aortic stenosis is currently the most frequently occurring valve pathology. Developments, such as transcatheter prostheses and rapid deployment prostheses, allow for the offer of a valve replacement to higher risk patients, but these techniques are linked with a higher need for a permanent pacemaker during the immediate postoperative period. METHODS We studied the incidence and the factors associated with permanent pacemaker implantation after aortic valve replacement with Edwards Intuity rapid deployment prosthesis. RESULTS Between October 2012 and December 2016, the Edwards Intuity prosthesis was implanted in 71 patients (68% male, 75.3 ± 5 years old). Six patients (8%) required a permanent pacemaker during immediate postoperative period. Univariate analysis showed that a history of acute myocardial infarction (AMI) (P = .046, B = 7.5, 95% CI [1.039-54.1]) and preoperative amiodarone (P = .009, B = 31.5; 95% CI [2.32-426]) were associated with a higher need for a pacemaker during the postoperative period. CONCLUSIONS The incidence of permanent pacemaker implantation during the immediate postoperative period of aortic valve replacement with Edwards Intuity prosthesis was 8%, a value which is within the limits reported for conventional aortic prostheses. Preoperative amiodarone treatment and previous AMI may increase the need for a pacemaker during the postoperative period of these aortic prostheses.
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Affiliation(s)
- José María Arribas
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Laura Soriano
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Maydelin Lorenzo
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Muñoz
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Rubén Taboada
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Antonio Jiménez
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Juan Martínez
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Julio García-Puente
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Gutiérrez
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Sergio Manzano
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Sergio Cánovas
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
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Leyva F, Qiu T, McNulty D, Evison F, Marshall H, Gasparini M. Long-term requirement for pacemaker implantation after cardiac valve replacement surgery. Heart Rhythm 2017; 14:529-534. [DOI: 10.1016/j.hrthm.2016.11.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Indexed: 11/28/2022]
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Al-Ghamdi B, Mallawi Y, Shafquat A, Ledesma A, AlRuwaili N, Shoukri M, Khan S, Al Sanei A. Predictors of Permanent Pacemaker Implantation After Coronary Artery Bypass Grafting and Valve Surgery in Adult Patients in Current Surgical Era. Cardiol Res 2016; 7:123-129. [PMID: 28197280 PMCID: PMC5295576 DOI: 10.14740/cr480w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 11/11/2022] Open
Abstract
Background Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era. Methods After exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed. Results Patients’ mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up. Conclusions Patients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long-term follow-up. We recommend preoperative assessment for risk of requiring postoperative PPM, to counsel patients about this risk and early PPM implantation in high-risk patients who are PPM dependent after surgery.
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Affiliation(s)
- Bandar Al-Ghamdi
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Yaseen Mallawi
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Azam Shafquat
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Alexandra Ledesma
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nadiah AlRuwaili
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed Shoukri
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; National Biotechnology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shahid Khan
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Aly Al Sanei
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Challenge for Perceval: Aortic Valve Replacement With Small Sutureless Valves–A Multicenter Study. Ann Thorac Surg 2015; 99:1248-54. [DOI: 10.1016/j.athoracsur.2014.09.090] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 11/21/2022]
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KOGAN ALEXANDER, STERNIK LEONID, BEINART ROY, SHALABI AMJAD, GLIKSON MICHAEL, SPIEGELSTEIN DANNY, LEVIN SHANY, RAANANI EHUD. Permanent Pacemaker Insertion Following Isolated Aortic Valve Replacement before and after the Introduction of TAVI. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:424-30. [DOI: 10.1111/pace.12569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/22/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022]
Affiliation(s)
- ALEXANDER KOGAN
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - LEONID STERNIK
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - ROY BEINART
- Davidai Arrhythmia Center, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - AMJAD SHALABI
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - MICHAEL GLIKSON
- Davidai Arrhythmia Center, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - DANNY SPIEGELSTEIN
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - SHANY LEVIN
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - EHUD RAANANI
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Elahi MM, Chuang A, Ewing MJ, Choi CH, Grant PW, Matata BM. One problem two issues! Left ventricular systolic and diastolic dysfunction in aortic stenosis. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:10. [PMID: 25332986 DOI: 10.3978/j.issn.2305-5839.2013.06.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/19/2013] [Indexed: 01/19/2023]
Abstract
Reports suggested that immediate post-aortic valve replacement (AVR); left ventricular (LV) dysfunction may be an important risk for morbidity and mortality in patients requiring positive inotropic support. Several factors have been identified as significant prognostic factors i.e., LV systolic dysfunction, LV diastolic dysfunction (LV-DD), heart failure and myocardial infarction (MI). Specific to pathophysiological changes associated with AS, markers of systolic LV function (e.g., LVEF) have been extensively studied in management, yet only a few studies have analysed the association between LV-DD and immediate post-operative LV dysfunction This review brings together the current body of evidence on this issue.
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Affiliation(s)
- Maqsood M Elahi
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
| | - Anthony Chuang
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
| | - Michael J Ewing
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
| | - Charles H Choi
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
| | - Peter W Grant
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
| | - Bashir M Matata
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Texas A & M Health Science Center at Scott & White Memorial Hospital, Temple, TX, USA ; 2 Division of Cardiothoracic Surgery, Prince of Wales & Sydney Children's Hospital, Barker Street, Randwick, Sydney, NSW, Australia ; 3 Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, UK
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Pechlivanidis K, Onorati F, Petrilli G, Santini F, Milano A, Torre S, Calzaferri D, Mazzucco A, Faggian G. In which patients is transcatheter aortic valve replacement potentially better indicated than surgery for redo aortic valve disease? Long-term results of a 10-year surgical experience. J Thorac Cardiovasc Surg 2014; 148:500-8.e1. [DOI: 10.1016/j.jtcvs.2013.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/01/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
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Deering TF, Milla F, Cox J. Complete heart block following valve surgery: violation of the "primum non nocere" maxim or a minor secondary event? J Cardiovasc Electrophysiol 2013; 24:1388-90. [PMID: 24102656 DOI: 10.1111/jce.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas F Deering
- Piedmont Heart Institute Arrhythmia Center, Division of Cardiac Electrophysiology, Atlanta, Georgia, USA
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Ledwoch J, Franke J, Gerckens U, Kuck KH, Linke A, Nickenig G, Krülls-Münch J, Vöhringer M, Hambrecht R, Erbel R, Richardt G, Horack M, Zahn R, Senges J, Sievert H. Incidence and predictors of permanent pacemaker implantation following transcatheter aortic valve implantation: analysis from the German transcatheter aortic valve interventions registry. Catheter Cardiovasc Interv 2013; 82:E569-77. [PMID: 23475694 DOI: 10.1002/ccd.24915] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/19/2013] [Accepted: 03/03/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine predictors of permanent pacemaker (PPM) implantation up to 30 days after transcatheter aortic valve implantation (TAVI) in a prospective multicenter registry. BACKGROUND Conduction disorders requiring PPM implantation are one of the most common complications seen after TAVI. Knowledge about possible predictors may help to decrease the rate of PPM implantations. METHODS In total, 1347 consecutive patients who underwent TAVI in 22 centers were prospectively enrolled in the German transcatheter aortic valve interventions registry. Both Medtronic CoreValve™ and Edwards Sapien™ valves were implanted. Patients with preprocedurally implanted PPM or implantable cardioverter defibrillator were excluded from the analysis (n = 199). Regression analysis of baseline and procedure characteristics of the remaining 1,147 patients was performed. RESULTS Procedural success was achieved in 97.4% of the cases. The rate for PPM after TAVI was 33.7%. The absence of prior valve surgery, the use of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were identified as independent predictors for PPM after TAVI. Mortality at 30 days did not differ between patients with or without PPM necessity (6.0% vs. 8.1%, respectively; HR 0.72; CI (0.45-1.16); P = 0.17). CONCLUSIONS PPM is a common postprocedure requirement after TAVI. The absence of prior valve surgery, the implantation of Medtronic CoreValve™ prosthesis, and the presence of a porcelain aorta were independently associated with PPM after TAVI.
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Tas S, Aksoy E, Buyukbayrak F, Antal A, Donmez G, Bakal RB, Zeybek R, Sunar H. Prognostic significance of the absence of normal septal Q waves before aortic valve replacement. J Electrocardiol 2013; 46:368-74. [PMID: 23498092 DOI: 10.1016/j.jelectrocard.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Aim of this study was to investigate the prognostic significance of absence of septal Q waves in patients scheduled for aortic valve replacement. MATERIAL AND METHODS Sixty-one patients who underwent isolated aortic valve replacement for aortic stenosis were retrospectively evaluated. Septal Q waves were defined as Q waves of<2mm in amplitude and<40ms in width and absence of septal Q waves was defined as simultaneous loss of Q waves from at least three of the leads I, aVL, V5 and V6. Septal Q waves were absent in 17 patients (Group AQ, 27.8%) and were present in 44 patients (Group PQ, 72.1 %) preoperatively. Newly developed AV block>1st degree and newly developed left bundle branch block were primary endpoints. RESULTS Preoperatively, absence of normal septal Q waves was significantly associated with increased risk of postoperative AV block (HR: 11.18, range 1.37-91.21, 95% CI, p=0.02) whereas it was not associated with increased risk for newly developed LBBB (HR: 3.15 0.62-15.83, 95% CI, p=0.16). CONCLUSION Absence of normal septal Q waves in the preoperative ECG may predict further delay in conduction which might develop in the early postoperative course of aortic valve replacement.
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Affiliation(s)
- Serpil Tas
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Autopsy finding of the Sapien XT valve from a patient who died suddenly after transcatheter aortic valve replacement. Cardiovasc Interv Ther 2013; 28:267-71. [DOI: 10.1007/s12928-012-0153-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/13/2012] [Indexed: 11/27/2022]
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Schroeter T, Linke A, Haensig M, Merk DR, Borger MA, Mohr FW, Schuler G. Predictors of permanent pacemaker implantation after Medtronic CoreValve bioprosthesis implantation. Europace 2012; 14:1759-63. [DOI: 10.1093/europace/eus191] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
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Song Z, Lehr EJ, Wang S. An alternative subcoronary implantation technique decreases the risk of complete heart block after stentless aortic valve replacement. J Cardiovasc Dis Res 2012; 3:46-51. [PMID: 22346147 PMCID: PMC3271683 DOI: 10.4103/0975-3583.91594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Context: Stentless aortic valve prostheses have excellent hemodynamic profiles, but may be associated with an increased postoperative heart block when compared to conventional prostheses. Aims: To assess the effect of an alternative subcoronary implantation technique on postoperative complete heart block (CHB) and permanent pacemaker implantation (PPI) following aortic valve replacement (AVR) with stentless tissue valves. Settings and Design: A total of 130 consecutive patients undergoing AVR with stentless tissue valves by a single surgeon were studied retrospectively. Materials and Methods: A stentless tissue valve was implanted into 80 patients using the conventional modified subcoronary implantation technique, and 50 patients received a stentless tissue valve by an alternative subcoronary technique in which the inflow suture line is raised at the level of right-non coronary commissure. Data were collected at the time of hospital discharge and at 6–12 months postoperatively. Statistical Analysis Used: Independent samples t-test was used to compare continuous variables, and categorical variables were compared with the chi-square test. Results: Use of this new method reduced postoperative CHB (4.0% vs. 16.3%, P = 0.033), with fewer patients requiring PPI in the early postoperative period (6.0% vs. 18.8%, P = 0.041). Echocardiographic examination showed no differences in the effective orifice area, peak and mean aortic valve gradients, or left ventricular mass index between groups. Trivial or mild aortic regurgitation was found in 3.9% of patients with the conventional modified technique and 4.0% of patients undergoing the alternative technique, during follow-up (P > 0.05). Conclusions: Compared to the conventional subcoronary implantation technique, the alternative subcoronary implantation technique reduces the incidence of new CHB and the requirement of PPI following AVR with stentless tissue valves while preserving mid-term hemodynamic function.
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Affiliation(s)
- Zhigang Song
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, Spence MS, Brown S, Khan SQ, Walker N, Trivedi U, Hutchinson N, De Belder AJ, Moat N, Blackman DJ, Levy RD, Manoharan G, Roberts D, Khogali SS, Crean P, Brecker SJ, Baumbach A, Mullen M, Laborde JC, Hildick-Smith D. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation 2011; 123:951-60. [PMID: 21339482 DOI: 10.1161/circulationaha.109.927152] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model. METHODS AND RESULTS Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM. CONCLUSION One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
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Affiliation(s)
- M Z Khawaja
- UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK
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RAZA SYEDS, LI JIANMING, JOHN RANJIT, CHEN LINY, THOLAKANAHALLI VENKATAKRISHNAN, MBAI MACKENZIE, ADABAG ASELCUK. Long-Term Mortality and Pacing Outcomes of Patients with Permanent Pacemaker Implantation after Cardiac Surgery. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:331-8. [DOI: 10.1111/j.1540-8159.2010.02972.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bates MGD, Matthews IG, Fazal IA, Turley AJ. Postoperative permanent pacemaker implantation in patients undergoing trans-catheter aortic valve implantation: what is the incidence and are there any predicting factors? Interact Cardiovasc Thorac Surg 2010; 12:243-53. [PMID: 21098508 DOI: 10.1510/icvts.2010.256578] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The issue was to determine the incidence and predictors of postoperative permanent pacemaker (PPM) implantation in patients undergoing trans-catheter aortic valve implantation (TAVI) for symptomatic calcific aortic stenosis and to compare this to the known risks of this complication following surgical aortic valve replacement (AVR). Using the reported search method 3071 articles were identified, of which 94 were relevant to the procedure of TAVI and 14 were deemed to represent the best evidence. All 14 studies, including both multi-centre registries and single-centre retrospective case series containing ≥30 patients, reported incidence of postoperative PPM implantation. Five of these studies also assessed predictors of the need for postoperative PPM implantation. The author, journal, date and country of publication, study type, level of evidence, patient group, outcomes and results were tabulated for these studies. We conclude that the current best available evidence suggests that the mean incidence of PPM implantation following TAVI is 14.2% (range 0-34%, median 9.7%), although this appears higher with the CoreValve prosthesis (five studies, mean 20.8%, range 9.3-30.0%) than with the Edwards-Sapien prosthesis (six studies, mean 5.4%, range 0-10.1%). The mean incidences of PPM implantation overall and when using the CoreValve prosthesis are higher than the mean incidence of 7.0% (range 3-11.8%, median 7.2%) following conventional AVR and may be explained by distinct differences between the patient groups involved and the procedure performed. Indications for PPM implantation appear to occur early in the postoperative period following TAVI and there is little evidence of recovery following atrioventricular block (AVB). New onset persistent left bundle branch block is common following TAVI but the significance and follow-up required is unclear. Independent predictors of PPM requirement following TAVI include use of the CoreValve prosthesis and evidence of conduction system dysfunction, either pre-existing right bundle branch block or AVB at the time of TAVI. All patients should be made aware of the high risk of PPM implantation with TAVI.
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Affiliation(s)
- Matthew G D Bates
- Institute for Ageing and Health, Newcastle University, and Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne NE2 4HH, UK.
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Murtuza B, Pepper JR, Jones C, Nihoyannopoulos P, Darzi A, Athanasiou T. Does stentless aortic valve implantation increase perioperative risk? A critical appraisal of the literature and risk of bias analysis. Eur J Cardiothorac Surg 2010; 39:643-52. [PMID: 20850984 DOI: 10.1016/j.ejcts.2010.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/25/2010] [Accepted: 08/05/2010] [Indexed: 11/27/2022] Open
Abstract
Stentless aortic valve replacement has potential benefits in terms of valve hemodynamics and clinical outcomes, although these may be offset by greater technical complexity of implantation with longer cardiopulmonary bypass and cross-clamp times compared with stented valves. Meta-analyses of the small number of published randomized trials have been limited by their lack of critical synthesis of the literature, including evaluation of the Risk of Bias. Our objective was to determine whether stentless aortic valves increase perioperative risk of mortality. We also examined secondary clinical outcomes of neurological, renal and respiratory complications as well as hemodynamic changes reported by studies following implantation of the two types of aortic prosthesis. The methodology used to answer this question was a rigorous meta-analysis of randomized controlled trials, using bias-assessment techniques designed to address limitations of conventional meta-analysis. Our findings show that many of the existing randomized trials have a high or uncertain risk of bias. Analysis of studies with low risk of bias reveals that stentless valves do not increase perioperative risk in terms of 30-day mortality and morbidity though neither do they exhibit benefits in hemodynamics or clinical outcomes compared with stented valves. Larger, more stringent randomized studies would be required to identify any robust clinical difference.
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Affiliation(s)
- Bari Murtuza
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, Faculty of Medicine, Imperial College, UK.
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Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis. Am Heart J 2010; 159:497-503. [PMID: 20211315 DOI: 10.1016/j.ahj.2009.12.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 12/14/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac conduction disorders and requirement for permanent pacemaker implantation (PPI) are not uncommon after surgical aortic valve replacement and have important clinical implications. We aimed to investigate the incidence of cardiac conduction disorders after percutaneous aortic valve implantation (PAVI) and to identify possible clinical factors associated with their development. METHODS We studied 34 patients (mean age 80 +/- 8 years, 18 male) who underwent PAVI with the CoreValve bioprosthesis (Corevalve Inc, Irvine, CA). Electrocardiographic evaluation was performed pre- and postprocedurally, and at 1-week and 1-month follow-up. Other clinical variables were obtained from the medical history, echocardiography, and angiography. RESULTS After PAVI, 7 patients required PPI, all of whom developed total atrioventricular block within 3 days postprocedurally. A smaller left ventricular outflow tract diameter (20.3 +/- 0.5 vs 21.6 +/- 1.8 cm, P = .01), more left-sided heart axis (-20 degrees +/- 29 degrees vs 19 degrees +/- 36 degrees , P = .02), more mitral annular calcification (10 +/- 1 vs 5 +/- 4 mm, P = .008), and a smaller postimplantation indexed effective orifice area (0.86 +/- 0.20 vs 1.10 +/- 0.26 cm(2)/m(2), P = .04) were associated with PPI. The incidence of new left bundle-branch block (LBBB) was 65% and was associated with a deeper implantation of the prosthesis: 10.2 +/- 2.3 mm in the new-LBBB group versus 7.7 +/- 3.1 mm in the non-LBBB group (P = .02). CONCLUSIONS Percutaneous aortic valve implantation with the CoreValve prosthesis results in a high incidence of total atrioventricular block requiring PPI and new-onset LBBB. Preexisting disturbance of cardiac conduction, a narrow left ventricular outflow tract, and the severity of mitral annular calcification predict the need for permanent pacing, whereas the only factor shown to be predictive for new-onset LBBB is the depth of prosthesis implantation.
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Nardi P, Pellegrino A, Scafuri A, Bellos K, De Propris S, Polisca P, Chiariello L. Permanent pacemaker implantation after isolated aortic valve replacement: incidence, risk factors and surgical technical aspects. J Cardiovasc Med (Hagerstown) 2010; 11:14-9. [DOI: 10.2459/jcm.0b013e32832f9fde] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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HUYNH HIEU, DALLOUL GHASSAN, GHANBARI HAMID, BURKE PETER, DAVID MARIAM, DACCARETT MARCOS, MACHADO CHRISTIAN, DAVID SHUKRI. Permanent Pacemaker Implantation Following Aortic Valve Replacement: Current Prevalence and Clinical Predictors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1520-5. [DOI: 10.1111/j.1540-8159.2009.02552.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J 2009; 157:860-6. [PMID: 19376312 DOI: 10.1016/j.ahj.2009.02.016] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 02/07/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Changes in atrioventricular (AV) conduction and need for permanent pacemaker (PPM) are a recognized complication after open aortic valve replacement. We hypothesized that the need for PPM after CoreValve (Corevalve Inc, Irvine, CA) can be predicted with a combination of baseline variables. METHODS In patients undergoing transcatheter aortic valve implantation, potential clinical, electrocardiographic and echocardiographic predictors of permanent pacing requirement were studied. RESULTS Between January 2007 and March 2008, 34 patients with severe symptomatic aortic stenosis were recruited in a single center. Mean age was 84.4 years (SD 5.4, range 71-93). Of 34 cases paced at baseline, 3 (8.8%) were excluded from this analysis, as was the single periprocedural mortality. Of the remaining 30, 10 underwent permanent pacemaker implantation during the same admission (33.3%). PPM was for prolonged high-grade AV block in 4 cases, episodic high-grade AV block in 5, and sinus node disease in 1. Need for pacemaker was correlated to left axis deviation at baseline (P = .004, r = 0.508) and left bundle-branch block with left axis deviation (P = .002, r = 0.548). It was related to diastolic interventricular septal dimension on transthoracic echocardiography >17 mm (P = .045, r = 0.39) and the baseline thickness of the native noncoronary cusp (P = .002, r = 0.655). A susceptibility model was generated, and if at least one of (1) left bundle-branch block with left axis deviation, (2) interventricular septal dimension >17 mm, or (3) noncoronary cusp thickness >8 mm was present, the likelihood of PPM could be predicted with 75% sensitivity and 100% specificity and a receiver operating characteristic curve area of 0.93 +/- 0.055 (P < .001). CONCLUSIONS After transcatheter aortic valve implantation with CoreValve, permanent pacing was performed in around a third of patients and we present preliminary concepts towards a predictive model for this phenomenon.
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CALVI VALERIA, PUZZANGARA EUGLENA, PRUITI GIUSIPAOLA, CONTI SERGIO, DI GRAZIA ANGELO, USSIA GIANPAOLO, CAPODANNO DAVIDE, TAMBURINO CORRADO. Early Conduction Disorders Following Percutaneous Aortic Valve Replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S126-30. [DOI: 10.1111/j.1540-8159.2008.02298.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elahi M, Asopa S, Khan J. The right choice of prosthesis for patients undergoing aortic valve surgery: searching the truth. ACTA ACUST UNITED AC 2007; 9:77-81. [PMID: 17573580 DOI: 10.1080/17482940601173121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aortic valve surgery is suggested when native aortic valve is diseased and complications outweigh the risks. Choice of prosthesis for aortic valve surgery is vastly undetermined, in part due to the varied options (bioprosthetic, mechanical prosthesis, homografts and allografts) available. The technical issues during valve surgery and the anticoagulation concerns along with the patient type with respect to age, ethnicity, sex and quality of life do contribute to the challenge for deciding the type of valve prosthesis best substituted to the diseased native valve. Here we attempt to unravel the controversies and present a holistic approach towards settling on the best possible prosthesis for a diseased aortic valve.
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Affiliation(s)
- Maqsood Elahi
- Wessex Cardiothoracic Centre, General/BUPA Hospital, Southampton, Hampshire, UK.
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