Document Detail


Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time?
MedLine Citation:
PMID:  23300203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Hassina Baraki; Ammar Al Ahmad; Stefan Jeng-Singh; Shunsuke Saito; Jan Dieter Schmitto; Bernhard Fleischer; Axel Haverich; Ingo Kutschka
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Publication Detail:
Type:  Journal Article     Date:  2013-01-08
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  16     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-08-30     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  476-81     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Valve / surgery*
Cardiac Pacing, Artificial* / adverse effects,  mortality
Chi-Square Distribution
Electrocardiography
Female
Heart Block / diagnosis,  etiology,  mortality,  physiopathology,  therapy*
Heart Conduction System / physiopathology*
Heart Valve Prosthesis Implantation / adverse effects*,  mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Pacemaker, Artificial*
Recovery of Function
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):481   [PMID:  23504750 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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