Limongelli G, Ducceschi V, D'Andrea A, Renzulli A, Sarubbi B, De Feo M, Cerasuolo F, Calabrò R, Cotrufo M
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Heart. 2003 Aug;89(8):901-4. doi: 10.1136/heart.89.8.901.
To identify perioperative clinical predictors of permanent pacemaker implantation following aortic valve replacement.
Prospective cohort study on 276 patients submitted for aortic valve replacement: 267 patients (mean (SD) age, 57.5 (14) years) with no conduction disturbances, and nine patients (67.7 (5) years) with severe conduction disturbances requiring permanent pacing; 65 perioperative variables (38 preoperative, eight intraoperative, and 19 postoperative) were considered.
Nine patients (3.2%) had irreversible second or third degree atrioventricular (AV) block requiring permanent pacing. Risk factors for permanent pacing identified by univariate analysis were: preoperative: additional valvar disease, aortic regurgitation, myocardial infarction, pulmonary hypertension, anaemia, use of digitalis; intraoperative: cardiac arrest; postoperative: cardiac arrest, conduction disturbances, electrolytic imbalance, angiotensin converting enzyme inhibitor use. Multivariate logistic regression analysis identified preoperative aortic regurgitation (p < 0.005; odds ratio (OR) 6.6, 95% confidence interval (CI) 1.6 to 12.2), myocardial infarction (p < 0.0005; OR 15.2, 95% CI 6.3 to 19.9), pulmonary hypertension (p < 0.005; OR 12.5, 95% CI 3.2 to 18.3), and postoperative electrolyte imbalance (p < 0.01; OR 4.5, 95% CI 1.3 to 6.4).
Irreversible AV block requiring permanent pacemaker implantation is an uncommon condition following aortic valve replacement. Previous aortic regurgitation, myocardial infarction, pulmonary hypertension, and postoperative electrolyte imbalance should be considered in order to identify patients at increased risk for advanced AV block.
确定主动脉瓣置换术后永久性起搏器植入的围手术期临床预测因素。
对276例行主动脉瓣置换术的患者进行前瞻性队列研究：267例（平均（标准差）年龄57.5（14）岁）无传导障碍，9例（67.7（5）岁）有严重传导障碍需要永久性起搏；考虑了65个围手术期变量（38个术前、8个术中、19个术后）。
9例（3.2%）发生不可逆的二度或三度房室传导阻滞，需要永久性起搏。单因素分析确定的永久性起搏危险因素为：术前：合并瓣膜疾病、主动脉瓣反流、心肌梗死、肺动脉高压、贫血、使用洋地黄；术中：心脏骤停；术后：心脏骤停、传导障碍、电解质失衡、使用血管紧张素转换酶抑制剂。多因素logistic回归分析确定术前主动脉瓣反流（p<0.005；比值比（OR）6.6，95%置信区间（CI）1.6至12.2）、心肌梗死（p<0.0005；OR 15.2，95%CI 6.3至19.9）、肺动脉高压（p<0.005；OR 12.5，95%CI 3.2至18.3）和术后电解质失衡（p<0.01；OR 4.5，95%CI 1.3至6.4）。
主动脉瓣置换术后需要永久性起搏器植入的不可逆房室传导阻滞并不常见。应考虑既往主动脉瓣反流、心肌梗死、肺动脉高压和术后电解质失衡，以识别发生高度房室传导阻滞风险增加的患者。
