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Cheung CC, Mori S, Gerstenfeld EP. Iatrogenic Atrioventricular Block. Cardiol Clin 2023; 41:419-428. [PMID: 37321692 DOI: 10.1016/j.ccl.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury. In this article, we summarize the common causes for iatrogenic AV block, predictors for AV block, and general management considerations.
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Affiliation(s)
- Christopher C Cheung
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Center of the Health Science, #46-131, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
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Yazdani KO, Shafiee A, Heidari A, Ahmadi-Tafti H, Yaminisharif A. The prevalence of permanent pacemaker implantation after open-heart surgeries; eight years of experience in Tehran heart center. BMC Cardiovasc Disord 2023; 23:166. [PMID: 36991343 PMCID: PMC10062002 DOI: 10.1186/s12872-023-03182-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND We aimed to evaluate the prevalence of permanent pacemaker implantation (PPI) among open-heart surgery patients. METHODS We reviewed data from 23 461 patients undergoing open-heart surgeries between 2009 and 2016 in our heart center in Iran. A total of 18 070 patients (77%) had coronary artery bypass grafting (CABG), 3 598 (15.3%) valvular surgeries, and 1 793 (7.6%) congenital repair procedures. Finally, 125 patients who received PPI following open-heart surgeries were enrolled in our study. We defined the demographic and clinical characteristics of all these patients. RESULTS PPI was required in 125 (0.53%) patients with an average age of 58 ± 15.3 years. The average hospitalization time after surgery and waiting time for PPI were 19.7 ± 10.2 and 11.4 ± 6.5 days, respectively. Atrial fibrillation was the dominant pre-operative cardiac conduction abnormality (29.6%). Also, the primary indication for PPI was complete heart block in 72 patients (57.6%). Patients in the CABG group were significantly older (P = 0.002) and were more likely to be male (P = 0.030). The valvular group longer bypass and cross-clamp times and had more left atrial abnormalities. In addition, the congenital defect group was younger and had longer ICU stay times. CONCLUSIONS Based on our study findings, PPI was required in 0.53% of patients following open-heart surgery due to damage to the cardiac conduction system. The current study paves the way for future investigations to identify possible predictors of PPI in patients undergoing open-heart surgeries.
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Affiliation(s)
- Kaveh Oraii Yazdani
- Department of Cardiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Akbar Shafiee
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hossein Ahmadi-Tafti
- Department of Cardiac Surgery, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Yaminisharif
- Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Electrophysiology, Tehran Heart Center, North Kargar Ave, Tehran, 1411713138, Iran.
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Mogilansky C, Massoudy P, Czesla M, Balan R. Conduction Disorders after Surgical Aortic Valve Replacement Using a Rapid Deployment Aortic Valve Prosthesis: Medium-Term Follow-Up. J Clin Med 2023; 12:jcm12052083. [PMID: 36902870 PMCID: PMC10004204 DOI: 10.3390/jcm12052083] [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: 01/05/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND We have previously reported that the incidence of postoperative conduction disorders, especially left bundle branch block (LBBB), after implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis (Edwards Lifesciences, Irvine, CA, USA), was significantly increased compared with conventional aortic valve replacement. We were now interested in how these disorders behaved at intermediate follow-up. METHODS All 87 patients who had undergone surgical aortic valve replacement (SAVR) using the rapid deployment Intuity™ Elite prosthesis and were shown to have conduction disorders at the time of hospital discharge were followed up after surgery. These patients' ECGs were recorded at least 1 year after surgery, and the persistence of the new postoperative conduction disorders was assessed. RESULTS At hospital discharge, 48.1% of the patients had developed new postoperative conduction disorders, with LBBB being the predominant conduction disturbance (36.5%). At medium-term follow-up (526 days, standard deviation (SD) = 169.6, standard error (SE) = 19.3 days, respectively), 44% of the new LBBB and 50% of the new right bundle branch block (RBBB) had disappeared. There was no new atrio-ventricular block III (AVB III) that occurred. One new pacemaker (PM) was implanted during follow-up because of AVB II Mobitz type II. CONCLUSIONS At medium-term follow-up after the implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis, the number of new postoperative conduction disorders, especially LBBB, has considerably decreased but remains high. The incidence of postoperative AV block III remained stable.
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Sassis L, Kefala-Karli P, Cucchi I, Kouremenos I, Demosthenous M, Diplaris K. Valve Repair in Aortic Insufficiency: A State-of-the-art Review. Curr Cardiol Rev 2023; 19:e270422204131. [PMID: 35490315 PMCID: PMC10201877 DOI: 10.2174/1573403x18666220427120235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.
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Affiliation(s)
| | | | - Irene Cucchi
- University of Nicosia, School of Medicine, Nicosia, Cyprus
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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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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6548864. [DOI: 10.1093/ejcts/ezac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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Abstract
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury. In this article, we summarize the common causes for iatrogenic AV block, predictors for AV block, and general management considerations.
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Affiliation(s)
- Christopher C Cheung
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Center of the Health Science, #46-131, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
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Salmi SJ, Nieminen T, Hartikainen J, Biancari F, Lehto J, Nissinen M, Malmberg M, Yannopoulos F, Savolainen J, Airaksinen J, Kiviniemi T. Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses: the CAREAVR study. Interact Cardiovasc Thorac Surg 2020; 31:398-404. [PMID: 32747953 DOI: 10.1093/icvts/ivaa119] [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: 09/27/2019] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to study the indications, long-term occurrence, and predictors of permanent pacemaker implantation (PPI) after isolated surgical aortic valve replacement with bioprostheses. METHODS The CAREAVR study included 704 patients (385 females, 54.7%) without a preoperative PPI (mean ± standard deviation age 75 ± 7 years) undergoing isolated surgical aortic valve replacement at 4 Finnish hospitals between 2002 and 2014. Data were extracted from electronic patient records. RESULTS The follow-up was median 4.7 years (range 1 day to 12.3 years). Altogether 56 patients received PPI postoperatively, with the median 507 days from the operation (range 6 days to 10.0 years). The PPI indications were atrioventricular block (31 patients, 55%) and sick sinus syndrome (21 patients, 37.5%). For 4 patients, the PPI indication remained unknown. A competing risks regression analysis (Fine-Gray method), adjusted with age, sex, diabetes, coronary artery disease, preoperative atrial fibrillation (AF), left ventricular ejection fraction, New York Heart Association class, AF at discharge and urgency of operation, was used to assess risk factors for PPI. Only AF at discharge (subdistribution hazard ratio 4.34, 95% confidence interval 2.34-8.03) was a predictor for a PPI. CONCLUSIONS Though atrioventricular block is the major indication for PPI after surgical aortic valve replacement, >30% of PPIs are implanted due to sick sinus syndrome during both short-term follow-up and long-term follow-up. Postoperative AF versus sinus rhythm conveys >4-fold risk of PPI. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02626871.
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Affiliation(s)
- Samuli J Salmi
- Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | | | - Fausto Biancari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Joonas Lehto
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Maunu Nissinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Jyri Savolainen
- Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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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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González Barbeito M, Estévez-Cid F, Pardo Martínez P, Velasco García de Sierra C, Iglesias Gil C, Quiñones Laguillo C, Cuenca Castillo JJ. Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses. J Thorac Dis 2019; 11:2945-2954. [PMID: 31463124 DOI: 10.21037/jtd.2019.07.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. Methods Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed. Results Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008). Conclusions In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.
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Affiliation(s)
| | - Francisco Estévez-Cid
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | - Carmen Iglesias Gil
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
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Fleerakkers J, Schepens M, Ranschaert W, Verrelst P, Graulus E. Aortic valve replacement using the Freedom SOLO stentless bioprosthesis: clinical and haemodynamic performance in 625 patients at medium-term follow-up. Eur J Cardiothorac Surg 2018; 54:1073-1080. [DOI: 10.1093/ejcts/ezy202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Marc Schepens
- Department of Cardiac Surgery, AZ St-Jan, Brugge, Belgium
| | | | - Paul Verrelst
- Department of Cardiac Surgery, AZ St-Jan, Brugge, Belgium
| | - Eric Graulus
- Department of Cardiac Surgery, AZ St-Jan, Brugge, Belgium
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Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis. J Thorac Cardiovasc Surg 2017; 154:1556-1565.e1. [DOI: 10.1016/j.jtcvs.2017.05.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 05/07/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022]
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Niclauss L, Delay D, Pfister R, Colombier S, Kirsch M, Prêtre R. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. Asian Cardiovasc Thorac Ann 2017; 25:350-356. [PMID: 28530122 DOI: 10.1177/0218492317712309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Permanent pacemaker implantation after surgical aortic valve replacement depends on patient selection and risk factors for conduction disorders. We aimed to identify risk criteria and obtain a selected group comparable to patients assigned to transcatheter aortic valve implantation. Methods Isolated sutured aortic valve replacements in 994 patients treated from 2007 to 2015 were reviewed. Demographics, hospital stay, preexisting conduction disorders, surgical technique, and etiology in patients with and without permanent pacemaker implantation were compared. Reported outcomes after transcatheter aortic valve implantation were compared with those of a subgroup including only degenerative valve disease and first redo. Results The incidence of permanent pacemaker implantation was 2.9%. Longer hospital stay ( p = 0.01), preexisting rhythm disorders ( p < 0.001), complex prosthetic endocarditis ( p = 0.01), and complex redo ( p < 0.001) were associated with permanent pacemaker implantation. Although prostheses were sutured with continuous monofilament in the majority of cases (86%), interrupted pledgetted sutures were used more often in the pacemaker group ( p = 0.002). In the subgroup analysis, the incidence of permanent pacemaker implantation was 2%; preexisting rhythm disorders and the suture technique were still major risk factors. Conclusion Permanent pacemaker implantation depends on etiology, preexisting rhythm disorders, and suture technique, and the 2% incidence compares favorably with the reported 5- to 10-fold higher incidence after transcatheter aortic valve implantation. Cost analysis should take this into account. Often dismissed as minor complication, permanent pacemaker implantation increases the risks of endocarditis, impaired myocardial recovery, and higher mortality if associated with prosthesis regurgitation.
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Affiliation(s)
- Lars Niclauss
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Dominique Delay
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raymond Pfister
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sebastien Colombier
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - René Prêtre
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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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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Tretter JT, Spicer DE, Mori S, Chikkabyrappa S, Redington AN, Anderson RH. The Significance of the Interleaflet Triangles in Determining the Morphology of Congenitally Abnormal Aortic Valves: Implications for Noninvasive Imaging and Surgical Management. J Am Soc Echocardiogr 2016; 29:1131-1143. [DOI: 10.1016/j.echo.2016.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 10/20/2022]
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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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Borger MA, Dohmen PM, Knosalla C, Hammerschmidt R, Merk DR, Richter M, Doenst T, Conradi L, Treede H, Moustafine V, Holzhey DM, Duhay F, Strauch J. Haemodynamic benefits of rapid deployment aortic valve replacement via a minimally invasive approach: 1-year results of a prospective multicentre randomized controlled trial. Eur J Cardiothorac Surg 2016; 50:713-720. [DOI: 10.1093/ejcts/ezw042] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/26/2016] [Accepted: 02/03/2016] [Indexed: 01/22/2023] Open
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Wahlers TCW, Haverich A, Borger MA, Shrestha M, Kocher AA, Walther T, Roth M, Misfeld M, Mohr FW, Kempfert J, Dohmen PM, Schmitz C, Rahmanian P, Wiedemann D, Duhay FG, Laufer G. Early outcomes after isolated aortic valve replacement with rapid deployment aortic valve. J Thorac Cardiovasc Surg 2016; 151:1639-47. [PMID: 26892076 DOI: 10.1016/j.jtcvs.2015.12.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 12/01/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Minimal access aortic valve replacement is associated with favorable clinical outcomes; however, several meta-analyses have reported significantly longer crossclamp times compared with a full sternotomy. We examined the procedural and early safety outcomes after isolated rapid deployment aortic valve replacement by surgical approach in patients enrolled in the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial. METHODS The Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial was a prospective, multicenter, single-arm study, with successful implants in 287 patients with aortic valve stenosis who underwent rapid deployment aortic valve replacement using the EDWARDS INTUITY Valve System (Edwards Lifesciences, Irvine, Calif). Patients were evaluated perioperatively for procedural times and technical success rates; at discharge, for hospital length of stay; and, at 30 days, for early adverse events. RESULTS A total of 158 patients underwent isolated aortic valve replacement through a full sternotomy (n = 71), upper hemisternotomy (n = 77), or right anterior thoracotomy (n = 10). Mean age at baseline was 75.7 ± 7.2 years. Mean aortic crossclamp and cardiopulmonary bypass times (minutes) were similar for full sternotomy and upper hemisternotomy, 43.5 ± 32.5/71.6 ± 41.8 and 43.1 ± 13.1/69.6 ± 19.1, respectively, and significantly longer for right anterior thoracotomy, 88.3 ± 18.6/122.2 ± 22.1 (P < .000). Early adverse event rates were similar, and in-hospital mortality rates were low regardless of surgical approach. CONCLUSIONS These data suggest that isolated rapid deployment aortic valve replacement through an upper hemisternotomy can lead to shorter crossclamp times than has been reported historically in the literature. This may facilitate minimal access aortic valve replacement by eliminating the issue of prolonged crossclamp times. Further, low in-hospital mortality and new permanent pacemaker implant rates were observed regardless of surgical approach.
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Steyers CM, Khera R, Bhave P. Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence. PLoS One 2015; 10:e0140340. [PMID: 26470027 PMCID: PMC4607414 DOI: 10.1371/journal.pone.0140340] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/22/2015] [Indexed: 01/09/2023] Open
Abstract
Background Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. Methods We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. Results A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6–72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Conclusions Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery.
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Affiliation(s)
- Curtis M Steyers
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Rohan Khera
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Prashant Bhave
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
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Thalmann M, Grubitzsch H, Matschke K, Glauber M, Tan E, Francois K, Amorim MJ, Hensens AG, Cesari F, Feyrer R, Diegeler A, Veit F, Repossini A. A European Multicenter Study of 616 Patients Receiving the Freedom Solo Stentless Bioprosthesis. Ann Thorac Surg 2015; 101:100-8. [PMID: 26443880 DOI: 10.1016/j.athoracsur.2015.06.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 06/20/2015] [Accepted: 06/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and performance of the Freedom Solo valve in aortic valve replacement by clinical and hemodynamic outcomes. METHODS Six hundred sixteen patients underwent aortic valve replacement in 18 European centers; mean age was 74.5 ± 5.9 years, 54.1% of the patients were male, and concomitant procedures were performed in 43.2% of the patients. The majority (69%) of the implanted sizes were 23 mm and 25 mm. RESULTS At 1 year, overall survival was 94.0%, whereas freedom from valve-related death was 98.6%. There were 9 (1.5%) early (≤ 30 days) and 27 (4.4%) late (>30 days) deaths. Early and late valve-related mortality was 0.3% (n = 2) and 1.1% (n = 7), respectively. Freedom from explant was 97.6%; 10 valves were explanted for endocarditis and 4 for paravalvular leak. There were 10 (1.6%) early and 5 (0.8%) late strokes. Atrioventricular block requiring pacemaker implant occurred in 8 (1.3%) and 1 (0.2%) patients in the early and late postoperative period, respectively. Thrombocytopenia was seen in 27 cases (4.4%) in the early postoperative period. Preoperatively, 93.8% of patients were in New York Heart Association functional classes II through IV, whereas at 1 year 96.9% of patients were in New York Heart Association functional classes I and II. At 1-year follow-up, mean and peak pressure gradients were 7.2 and 14.6 mm Hg, respectively. Indexed left ventricular mass decreased by 12% from 138 g/m(2) at discharge to 122 g/m(2) at 1 year. CONCLUSIONS At 1-year follow-up after Freedom Solo implantation, we found acceptable clinical results with low mortality and morbidity and good hemodynamic performance, confirming safety and effectiveness in this multicenter experience.
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Affiliation(s)
| | | | | | | | - Erwin Tan
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | | | | | | | | | - Alberto Repossini
- Cardiac Surgery, University of Brescia, Spedali Civili, Brescia, Italy
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Aktueller Stand der kathetergestützten Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Singh S, Ghayal P, Mathur A, Mysliwiec M, Lovoulos C, Solanki P, Klapholz M, Maher J. Unicuspid unicommissural aortic valve: an extremely rare congenital anomaly. Tex Heart Inst J 2015; 42:273-6. [PMID: 26175647 DOI: 10.14503/thij-13-3634] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unicuspid aortic valve is a rare congenital malformation that usually presents in the 3rd to 5th decade of life-and usually with severe aortic stenosis or regurgitation. It often requires surgical correction. Diagnosis can be made with 2- or 3-dimensional transthoracic or transesophageal echocardiography, cardiac computed tomography, or cardiac magnetic resonance imaging. We report the case of a 31-year-old man who presented with dyspnea on exertion due to severe aortic stenosis secondary to a unicuspid unicommissural aortic valve. After aortic valve replacement, this patient experienced complete heart block that required the placement of a permanent pacemaker.
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MAAN ABHISHEK, REFAAT MARWANM, HEIST EDWINKEVIN, PASSERI JONATHAN, INGLESSIS IGNACIO, PTASZEK LEON, VLAHAKES GUS, RUSKIN JEREMYN, PALACIOS IGOR, SUNDT THORALF, MANSOUR MOUSSA. Incidence and Predictors of Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:878-86. [DOI: 10.1111/pace.12653] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/06/2015] [Accepted: 04/25/2015] [Indexed: 12/16/2022]
Affiliation(s)
- ABHISHEK MAAN
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - MARWAN M. REFAAT
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | | | - JONATHAN PASSERI
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | | | - LEON PTASZEK
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - GUS VLAHAKES
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - JEREMY N. RUSKIN
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - IGOR PALACIOS
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - THORALF SUNDT
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
| | - MOUSSA MANSOUR
- Heart Center; Massachusetts General Hospital; Boston Massachusetts
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Glauber M, Ferrarini M, Miceli A. Rapid deployment aortic valves and minimally invasive aortic valve replacement: A perfect marriage of technology and technique? J Thorac Cardiovasc Surg 2015; 149:441-2. [DOI: 10.1016/j.jtcvs.2014.10.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
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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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A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement. Ann Thorac Surg 2015; 99:17-25. [DOI: 10.1016/j.athoracsur.2014.09.022] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022]
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Logar M, Lejko-Zupanc T. Infective endocarditis caused by Cellulomonas spp. in an intravenous drug user: case report. Wien Klin Wochenschr 2013; 125:334-6. [PMID: 23653152 DOI: 10.1007/s00508-013-0367-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/04/2013] [Indexed: 11/29/2022]
Abstract
Cellulomonas spp. are often believed to be of low virulence. There are only a few reports of human infections. We report the first case of endocarditis caused by Cellulomonas in an intravenous drug abuser. The diagnosis of infective endocarditis (IE) in this case was definite using the Duke criteria. The course of the disease was complicated with a heart failure and possible mycotic aneurysm in the left leg. After the end of antimicrobial therapy aortic valve replacement was done because of severe heart failure.
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Affiliation(s)
- Mateja Logar
- Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1000, Ljubljana, Slovenia.
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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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Piazza F, Santoro G, Russo MG. Aortic insufficiency due to ventricular septal defect (Laubry–Pezzi syndrome). J Cardiovasc Med (Hagerstown) 2013; 14:164-5. [DOI: 10.2459/jcm.0b013e3283515c30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Baraki H, Al Ahmad A, Jeng-Singh S, Saito S, Schmitto JD, Fleischer B, Haverich A, Kutschka I. Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? Interact Cardiovasc Thorac Surg 2013; 16:476-81. [PMID: 23300203 DOI: 10.1093/icvts/ivs555] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Permanent pacemaker (PPM) implantation is required in 3-8% of all patients undergoing aortic valve replacement (AVR). Our aim was to evaluate long-term PPM dependency and recovery of atrioventricular (AV) conduction disorders during follow-up in these patients. METHODS Since January 1997, a total of 2106 consecutive patients underwent isolated AVR at our institution. Of these, 138 patients (6.6%, 72 female, median age 71 (37-89) years) developed significant conduction disorders leading to PPM implantation postoperatively. Preoperative ECG showed normal sinus rhythm (n = 64), first degree AV block (n = 19), left bundle branch block (n = 13), right bundle branch block (n = 16), left anterior hemiblock (n = 14) and AV block with ventricular escape rhythm (n = 10). Atrial fibrillation was present in 23 patients. Pacemakers were implanted after a median of 7 (1-30) days following AVR. PPM dependency was analysed by ECG and pacemaker check during follow-up. RESULTS A total of 45 of 138 patients with postoperative PPM Implantation died during a mean follow-up time of 5.3 ± 4.7 years. A further 9 patients were lost to follow-up. Long-term survivals at 1, 5 and 10 years were 88%, 79% and 59%, respectively. Only 8 (10%) of 84 survivors were no longer pacemaker-dependent. The majority of patients (n = 66, 79%) required permanent ventricular stimulation, and the remaining 10 (13%) showed intermittent stimulation with a mean ventricular stimulation fraction of 73% (22-98%). CONCLUSIONS The majority of patients do not recover from AV conduction disorders after AVR. Since higher-grade AV blocks expose patients to a high risk of sudden death after surgery, we recommend early implantation of permanent pacemaker.
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Affiliation(s)
- Hassina Baraki
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Muñoz-García AJ, Hernández-García JM, Jiménez-Navarro MF, Alonso-Briales JH, Domínguez-Franco AJ, Fernández-Pastor J, Peña Hernández J, Barrera Cordero A, Alzueta Rodríguez J, de Teresa-Galván E. Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System. JACC Cardiovasc Interv 2012; 5:533-539. [DOI: 10.1016/j.jcin.2012.03.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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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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Pilgrim T, Wenaweser P, Windecker S. Comparing outcomes between surgical aortic valve replacement and transcatheter aortic valve implantation. Interv Cardiol 2010. [DOI: 10.2217/ica.10.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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