Rahmanian Parwis B, Eghbalzadeh Kaveh, Kaya Süreyya, Menghesha Hruy, Gerfer Stephen, Liakopoulos Oliver J, Choi Yeong-Hong, Wahlers Thorsten
Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany.
Interact Cardiovasc Thorac Surg. 2018 Aug 1;27(2):215-221. doi: 10.1093/icvts/ivy056.
Rapid-deployment aortic valve replacement (RD-AVR) potentially reduces procedure times providing excellent haemodynamic results compared to standard tissue aortic valve replacement. However, concerns have been raised regarding higher rates of postoperative pacemaker (PPM) requirement compared to standard aortic valve replacement. In this study, we sought to determine the PPM rate and its potential risk factors in RD-AVR patients.
Between 2011 and 2017, 193 patients underwent RD-AVR. The main outcome investigated was PPM. Other outcome parameters included hospital mortality, major morbidity, length of stay and discharge condition. Predictors of PPM were determined using multivariable regression models.
Isolated RD-AVR was performed in 72 (37%) patients and 121 (63%) patients underwent combined RD-AVR [coronary artery bypass grafting (n = 110), mitral repair (n = 6) and others (n = 5)]. Aortic cross-clamp and cardiopulmonary bypass times were 57.1 ± 25.1 min and 90.0 ± 40.1 min in the overall RD-AVR population and 39.4 ± 13.5 min and 67.6 ± 24.5 min, respectively, in isolated RD-AVR procedures. PPM occurred in 20 (10.4%) patients. Multivariable analysis revealed bypass grafting of the circumflex artery [odds ratio = 2.8] and preoperative right branch bundle block (odds ratio = 11.7) as independent predictors for PPM.
RD-AVR is a safe and simple procedure resulting in favourable short aortic cross-clamp and cardiopulmonary bypass times and considerable low gradients in postoperative echocardiography. PPM following isolated RD-AVR remains in the range of standard aortic valve replacement. However, patients undergoing concomitant coronary artery bypass grafting, particularly of the circumflex artery, face a 3-fold increased risk for PPM implantation enhanced if right branch bundle block is present. Follow-up examination is necessary to determine whether these patients remain pacer dependent during long-term follow-up.
与标准组织主动脉瓣置换术相比，快速部署主动脉瓣置换术（RD-AVR）可能会缩短手术时间，并提供出色的血流动力学结果。然而，与标准主动脉瓣置换术相比，术后起搏器（PPM）需求率较高引发了人们的担忧。在本研究中，我们试图确定RD-AVR患者的PPM率及其潜在危险因素。
2011年至2017年间，193例患者接受了RD-AVR。主要研究结局是PPM。其他结局参数包括医院死亡率、主要并发症、住院时间和出院情况。使用多变量回归模型确定PPM的预测因素。
72例（37%）患者接受了单纯RD-AVR，121例（63%）患者接受了联合RD-AVR[冠状动脉搭桥术（n = 110）、二尖瓣修复术（n = 6）和其他手术（n = 5）]。在整个RD-AVR人群中，主动脉阻断和体外循环时间分别为57.1±25.1分钟和90.0±40.1分钟，在单纯RD-AVR手术中分别为39.4±13.5分钟和67.6±24.5分钟。20例（10.4%）患者发生了PPM。多变量分析显示，回旋支动脉搭桥术[比值比 = 2.8]和术前右束支传导阻滞（比值比 = 11.7）是PPM的独立预测因素。
RD-AVR是一种安全、简单的手术，主动脉阻断和体外循环时间短，术后超声心动图显示梯度相当低。单纯RD-AVR后的PPM发生率仍在标准主动脉瓣置换术范围内。然而，接受同期冠状动脉搭桥术的患者，尤其是回旋支动脉搭桥术患者，如果存在右束支传导阻滞，PPM植入风险会增加3倍。需要进行随访检查，以确定这些患者在长期随访中是否仍依赖起搏器。
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