Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): a preliminary randomized clinical trial

Postoperative atrioventricular block after surgery for congenital heart disease: incidence, recovery and risks

OBJECTIVES

We aimed to determine the incidence of postoperative complete atrioventricular block, the time to recovery or permanent pacemaker implantation and the predictors for postoperative atrioventricular block after congenital heart surgery.

METHODS

Patients who underwent open-heart surgery from January 2001 to January 2024 were analysed and predictors of atrioventricular block were identified using a logistic regression model.

RESULTS

Among 9765 congenital heart surgeries, 333 (3.4%) were complicated by atrioventricular block, and 193 patients (1.9%) underwent permanent pacemaker implantation. The highest rates of atrioventricular block were found in patients who underwent repair of congenitally corrected transposition of the great arteries (27.3%), followed by Konno procedure (20.0%), mitral valve replacement (16.0%) and arterial switch with closure of ventricular septal defect and arch repair (15.0%). In 134 (1.4%) patients with transient atrioventricular block, the median time to resolution was 4 days (interquartile range: 2-8 days). After 7 postoperative days, 75% had resolved, and after 12 postoperative days, 90% had resolved. Risk factors for the development of atrioventricular block were older age at operation (odds ratio: 1.012, P = 0.001), preoperative endocarditis (2.422, P < 0.001), longer aortic cross-clamp time (1.018, P < 0.001) and high-risk procedures (1.397, P = 0.012).

CONCLUSIONS

Postoperative atrioventricular block is not rare after congenital heart surgery, with more than half of them needing permanent pacemaker implantation. Older age at operation, preoperative endocarditis, longer aortic cross-clamp time and high-risk procedures were risks for the development of atrioventricular block. Pacemaker implantation should be delayed to the 12th postoperative day, when 90% of transient blocks have resolved.

Effect of acute CORticosteroids on conduction defects after Transcatheter Aortic Valve Implantation: the CORTAVI study

AIMS

Conduction abnormalities, requiring a permanent pacemaker (PPM), are the most common electrical complications after transcatheter aortic valve implantation (TAVI). The exact mechanism for conduction system defects is not yet clear. The local inflammatory process and edema are thought to play a role in the development of electrical disorders. Corticosteroids are effective anti-inflammatory and antiedematous agents. We aim to investigate the potential protective effect of corticosteroids on conduction defects after TAVI.

METHODS

This is a retrospective study of a single center. We analyzed 96 patients treated with TAVI. Thirty-two patients received oral prednisone 50 mg for 5 days after the procedure. This population was compared with the control group. All patients were followed up after 2 years.

RESULTS

Of the 96 patients included, 32 (34%) were exposed to glucocorticoids after TAVI. No differences in age, preexisting right bundle branch block or left bundle branch block, or valve type were seen among patients exposed to glucocorticoids versus those who were unexposed. We observed no significant differences between the two groups in the overall frequency of new PPM implantations during hospitalization (12% vs. 17%, P  = 0.76). The incidence of atrioventricular block (AVB) (STx 9% vs. non-STx 9%, P  = 0.89), right bundle branch block (STx 6% vs. non-STx 11%, P  = 0.71), and left bundle branch block (STx 34% vs. non-STx 31%, P  = 0.9) was not significantly different between the STx and non-STx groups. At 2 years after TAVI, none of the patients had implanted PPM or had severe arrhythmias documented by 24-h Holter ECG or cardiac examination.

CONCLUSION

Oral prednisone treatment does not appear to significantly reduce the incidence of AVB requiring acute PPM implantation after TAVI.