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Frequency, predictors, and consequences of atrioventricular block after mitral valve repair
Patrick Meimoun1, Rachid Zeghdi, Nicola D'Attelis
1Department of Cardiovascular Surgery and Organ Transplantation, Hopital Broussais-Europeen George's Pompidou, University of Paris, Paris, France. pmeioun001@ch-compiegne.rss.fr
Abstract:
This study examines the incidence, predictors, and evolution of postoperative atrioventricular block (AVB) after mitral valve repair (MVR) in 115 consecutive patients using Carpentier's technique (between November 1996 and April 1997). Postoperative AVB occurred in 27 patients (23%). Third-degree AVB was found in 7 patients (6%) in the immediate postoperative period, but in 4 it was transient, resolving partially or completely before the seventh postoperative day. Second-degree AVB (Mobitz type I) occurred in 4 patients (3%) immediately after operation and resolved in all before hospital discharge. Isolated first-degree AVB occurred in 16 patients (14%) and was permanent in 12. Neither the preoperative variables nor the mitral procedures including anterior versus posterior leaflet repair were related to postoperative AVB. A lesser systemic hypothermia during surgery was the only, modestly independent predictor of postoperative AVB (odds ratio 1.53; 95% confidence interval 1.04 to 2.25; p = 0.031). Three patients (2.6%) had permanent pacemaker implantation, on average 18 days after operation, and all had persistent third-degree AVB. With a mean follow-up of 3 years, no recurrence or worsening of conduction disturbances, no further pacemaker implantation, and no late deaths were observed.
Insights
Postoperative atrioventricular block (AVB) after mitral valve repair (MVR) occurred in 23% of patients. Lower surgical hypothermia was a predictor, with most AVB cases resolving, though some required pacemakers.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrioventricular block (AVB) is a potential complication following mitral valve repair (MVR).
- Understanding the incidence and predictors of AVB is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, predictors, and long-term evolution of postoperative AVB after MVR.
- To identify factors associated with AVB development and persistence.
Main Methods:
- Retrospective analysis of 115 patients undergoing MVR using Carpentier's technique.
- Evaluation of preoperative variables, surgical details, and postoperative conduction disturbances.
- Assessment of AVB incidence, type, and need for pacemaker implantation.
Main Results:
- Postoperative AVB occurred in 23% of patients; third-degree AVB in 6% (transient in 4), second-degree in 3% (resolved), and first-degree in 14% (permanent in 12).
- Lower systemic hypothermia was a modest independent predictor of AVB (OR 1.53).
- 3% of patients required permanent pacemaker implantation for persistent third-degree AVB; no late recurrences or deaths were observed over 3 years.
Conclusions:
- Postoperative AVB after MVR is relatively common but often transient.
- Lower systemic hypothermia may increase AVB risk.
- Long-term outcomes for AVB after MVR are generally favorable, with low rates of permanent pacemaker dependency.