Thuraisingam Amalan, Newcomb Andrew E
Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia.
University of Melbourne Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Australia.
JTCVS Tech. 2021 Oct 18;10:219-226. doi: 10.1016/j.xjtc.2021.10.029. eCollection 2021 Dec.
There have been reports of postoperative conduction disturbances after rapid-deployment aortic valve replacement. Our objective was to assess electrocardiogram changes in patients undergoing this procedure and review the literature on this topic.
In this retrospective case series, clinical data were extracted from patient records at St Vincent's Hospital Melbourne and the Australia New Zealand Society of Cardiac and Thoracic Surgeons database. Electrocardiogram data were obtained at baseline and postoperatively on day 5 and at week 6 and reviewed for rhythm disturbances and intracardiac conduction problems. Pacemaker status was also recorded.
From 2013 to 2017, 100 consecutive patients underwent rapid-deployment aortic valve replacement with 1 valve type at our institution. Three patients were excluded because of paced rhythm preoperatively, leaving 97 patients (mean age 74.7 ± 8.12 years; 56.7% male) for analysis. Some 18.6% of patients developed new left bundle branch block at 5 days postoperatively and only 4.1% of patients found with persistent left bundle branch block at 6-week follow-up compared with preoperatively. No significant changes were observed in the frequencies of atrial fibrillation, first-degree heart block, and right bundle branch block. However, there was evidence of increases in paced rhythm and subsequent need for a permanent pacemaker. A total of 14 patients (14.4%) had a permanent pacemaker implanted at an average of 11.1 ± 2.9 days postoperatively.
Rhythm disturbances and conduction abnormalities are noted with the rapid-deployment aortic valves used at our institution, but appear comparable to other rapid-deployment aortic valve replacement bioprostheses. These abnormalities may be related to the effect of the sub-annular stent frame of the valve system and implantation technique.
有报道称快速植入主动脉瓣置换术后出现传导障碍。我们的目的是评估接受该手术患者的心电图变化，并回顾关于这一主题的文献。
在这个回顾性病例系列中，临床数据从墨尔本圣文森特医院的患者记录以及澳大利亚和新西兰心脏与胸外科医生协会数据库中提取。在基线、术后第5天和第6周获取心电图数据，并对心律失常和心内传导问题进行评估。同时记录起搏器状态。
2013年至2017年，我们机构连续100例患者接受了使用1种瓣膜类型的快速植入主动脉瓣置换术。3例患者因术前为起搏心律被排除，剩余97例患者（平均年龄74.7±8.12岁；56.7%为男性）进行分析。约18.6%的患者术后5天出现新的左束支传导阻滞，与术前相比，6周随访时仅有4.1%的患者存在持续性左束支传导阻滞。房颤、一度房室传导阻滞和右束支传导阻滞的发生率未观察到显著变化。然而，有证据表明起搏心律增加以及随后需要植入永久性起搏器。共有14例患者（14.4%）在术后平均11.1±2.9天植入了永久性起搏器。
我们机构使用的快速植入主动脉瓣会出现心律失常和传导异常，但似乎与其他快速植入主动脉瓣置换生物假体相当。这些异常可能与瓣膜系统的瓣环下支架框架及植入技术的影响有关。
