Repository logo

Browsing by Author "Figueiral, Marta Torres Branco da Cunha"

Now showing 1 - 1 of 1
  • Conduction disorders and their clinical impact after sutureless/rapid deployment aortic bioprostheses
    Publication . Figueiral, Marta Torres Branco da Cunha; Ferreira, Ricardo Miguel Santos
    Background: Aortic stenosis remains the number one heart valve pathology and its prevalence keeps increasing. The drive to improve the outcomes of SAVR, which remains as the gold standard treatment, brought to focus a new generation of bioprostheses, rapid deployment aortic valves (RDAV) and sutureless valves. These prostheses reduce aortic cross-clamping and CPB duration as well as myocardial ischemia. Shortening of procedure duration, shorter ICU and hospital stays, lower complication rates and better survival rates, are among some of the other expected benefits of using these bioprostheses. However, due to its structure and implementation method, some centers have reported a higher rate of conduction abnormalities and PPM implantation with rapid deployment bioprostheses. Objectives: The aim of this study was to investigate the incidence of conduction abnormalities after aortic valve replacement with rapid deployment/sutureless bioprostheses as well as its impact on immediate postoperative outcomes and other postoperative implications, such as permanent pacemaker (PPM) implantation. Methods: All patients undergoing aortic valve replacement between 14/05/2014 and 17/12/2019, in one center, were included. Patients requiring an additional procedure, with previous pacemaker implantation, reoperation cases and patients with missing pre or postoperative ECG data, were excluded from this study. Our cohort was divided into 2 groups, "PPM” group and “No PPM” group, that were compared. The primary end point was permanent pacemaker implantation and its postoperative outcomes. Secondary end points included operatory times, conduction and rhythmic postoperative disorders, clinical postoperative complications and identification of risk factors for in-hospital PPM implantation. Results: We studied 201 patients, all of which underwent isolated aortic valve replacement with a rapid deployment bioprosthesis. Overall, 26 PPM were implanted (12.9%). The uni and multivariate analysis found one independent risk factor associated with in-hospital PPM implantation: preoperative right bundle branch block (RBBB) (OR 11.7, p=0,001 and OR 7.28, p=0.020 for uni and multivariable analysis respectively). “PPM” group had more preoperative left bundle branch block (21.1% vs 11.6%, p<0.001) as well as right bundle branch block (26.3% vs 3.6%, p<0.001). “PPM” group also presented with longer ICU (4.7 ? 2.9 vs 2.8 ? 2.7, p=0.003) and hospital (10.0 ? 6.2 vs 6.1 ? 3.4, p=0.005) stays. Postoperatively, the “PPM” group had higher rates of stroke (7.7% vs 0.0%, p=0.016) and requirement of aminergic support for longer than 24 hours (60.0% vs 36.1%, p=0.028). There were no statistically significant differences between the two groups among the other outcomes studied. Conclusions: This study found a 12.9% rate of permanent pacemaker implantation after AVR with rapid deployment bioprostheses. Patients that required PPM implantation had significantly higher hospital and ICU stays, postoperative stroke rates and requirement of aminergic support for longer than 24 hours. Preoperative RBBB was identified as the single independent risk factor for in-hospital PPM implantation.
    2020-07-20Master thesis Open access Show more