D'Onofrio Augusto, Tessari Chiara, Bagozzi Lorenzo, Migliore Federico, Filippini Claudia, Cibin Giorgia, Pesce Rita, Francescato Annalisa, Gerosa Gino
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Department of Surgical Sciences, University of Turin, Turin, Italy.
Ann Cardiothorac Surg. 2020 Sep;9(5):396-407. doi: 10.21037/acs-2020-surd-14.
Rapid-deployment bioprostheses represent one of the newest aortic valve substitutes introduced into clinical practice. The aim of this retrospective single-center study was to evaluate the occurrence of conduction disorders (CDs) after rapid-deployment aortic valve implantation at discharge and at 1-year follow-up, and to identify risk factors for CDs and permanent pacemaker implantation (PPI).
All patients who reached 1-year follow-up after isolated or combined aortic valve replacement (AVR) with rapid-deployment bioprostheses (Intuity Elite, Edwards Lifesciences, Irvine, CA) at our institution were included in this study. Standard 12-lead electrocardiograms (ECGs) were recorded before the procedure (within 24 hours), after the procedure as soon as the patient was moved to the intensive care unit (ICU), every day during in-hospital stay and at 1-year follow-up. The primary endpoint was the incidence of postoperative CDs at discharge and at 1-year follow up. Patients were divided in two groups: those who developed the primary endpoint (Group CD) and those who didn't (Group Non-CD).
A total of 98 consecutive patients were included in the study. At discharge, the primary endpoint occurred in 40 patients (40.8%). In particular, new CDs and PPI occurred in 33 (33.7%) and in 7 (7.1%) patients, respectively. Valve size was the only independent predictor of primary endpoint at discharge. At 1-year, 30 patients (31.3%) presented with CDs or pacemaker-induced rhythm. In particular, in 25 patients of Group CD (64.1%), 1-year follow-up ECG revealed the persistence of the same CD as at discharge or pacemaker-induced rhythm, while 14 patients (35.9%) showed recovery of their CD. Age and prosthesis size were identified as independent predictors of CDs/pacemaker-induced rhythm at 1-year follow-up.
According to our data, nearly 40% of patients develop a new CD after rapid-deployment aortic valve implantation. Of these, one third recover after one year. Bioprosthesis size and age were identified as independent risk factors for occurrence of CD after surgery.
快速部署生物假体是引入临床实践的最新主动脉瓣替代品之一。这项回顾性单中心研究的目的是评估快速部署主动脉瓣植入术后出院时及1年随访时传导障碍（CDs）的发生率，并确定CDs和永久起搏器植入（PPI）的危险因素。
本研究纳入了在我院接受孤立或联合主动脉瓣置换术（AVR）并使用快速部署生物假体（Intuity Elite，爱德华生命科学公司，加利福尼亚州欧文市）后达到1年随访的所有患者。在手术前（24小时内）、手术后患者转入重症监护病房（ICU）后、住院期间每天以及1年随访时记录标准12导联心电图（ECG）。主要终点是出院时及1年随访时术后CDs的发生率。患者分为两组：发生主要终点的患者（CD组）和未发生的患者（非CD组）。
本研究共纳入98例连续患者。出院时，40例患者（40.8%）出现主要终点。具体而言，分别有33例（33.7%）和7例（7.1%）患者出现新的CDs和PPI。瓣膜大小是出院时主要终点的唯一独立预测因素。1年时，30例患者（31.3%）出现CDs或起搏器诱导的心律。具体而言，在CD组的25例患者（64.1%）中，1年随访心电图显示与出院时相同的CD或起搏器诱导的心律持续存在，而14例患者（35.9%）的CD恢复。年龄和假体大小被确定为1年随访时CDs/起搏器诱导心律的独立预测因素。
根据我们的数据，近40%的患者在快速部署主动脉瓣植入术后出现新的CDs。其中，三分之一在一年后恢复。生物假体大小和年龄被确定为术后发生CD的独立危险因素。
