González Barbeito Miguel, Estévez-Cid Francisco, Pardo Martínez Patricia, Velasco García de Sierra Carlos, Iglesias Gil Carmen, Quiñones Laguillo Cristina, Cuenca Castillo José Joaquín
Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain.
Department of Cardiology, A Coruña University Hospital Complex, A Coruña, Spain.
J Thorac Dis. 2019 Jul;11(7):2945-2954. doi: 10.21037/jtd.2019.07.27.
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.
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.
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).
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.
主要目的是分析在我们的主动脉瓣置换系列中，Perceval S植入技术的改进对需要永久起搏器的术后房室传导阻滞发生率的影响。此外，我们试图确定与该并发症出现相关的危险因素。
截至2018年7月，我们中心使用Perceval S进行了572例瓣膜置换术。采用改良技术（n = 302）。微创方法（n = 340）。相关冠状动脉手术（n = 95）。排除术前有起搏器的患者（n = 27）和相关二尖瓣或三尖瓣手术患者（n = 26）。我们分析了可能影响术后房室传导阻滞增加的相关变量。所采用的技术、室内传导障碍以及术前/术中特征。分析了改良技术的影响。
519例使用Perceval S进行主动脉瓣置换术。年龄（岁）（中位数77，四分位间距8）。身高（厘米）（159，13.5）。欧洲心脏手术风险评估系统II（%）（2.25，2.27）。术后房室传导阻滞标准技术（n = 23，10.14%）。改良技术（n = 14，4.30%）（P = 0.009）。多因素回归分析。最终模型AUC = 0.740，最大模型AUC = 0.774（P>0.05）。包括：所使用的技术（P = 0.024）、身高（P = 0.043）以及室内传导障碍、右束支传导阻滞（P = 0.005）、三分支传导阻滞（P = 0.008）。
根据我们的经验，在使用Perceval S进行主动脉瓣置换时，改良技术显著降低了需要永久起搏器的术后房室传导阻滞的发生率。术前心电图存在右束支传导阻滞、三分支传导阻滞以及患者身高与阻滞风险增加相关。
