| Pacemaker dependency after isolated aortic valve replacement: do conductance disorders recover over time? | |
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MedLine Citation:
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PMID: 23300203 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVESPermanent 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.METHODSSince 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.RESULTSA 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%).CONCLUSIONSThe 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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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2013-1-8 |
Journal Detail:
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Title: Interactive cardiovascular and thoracic surgery Volume: - ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101158399 Medline TA: Interact Cardiovasc Thorac Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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