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Lesions of conduction tissue complicating aortic valvular replacement
Chest
|May 1, 1976
Summary
Cardiac conduction system damage after aortic valve replacement is common. Sutures cause traumatic lesions, frequently leading to abnormal heart rhythms, especially in patients with bicuspid aortic valves.
Area of Science:
- Cardiovascular Pathology
- Cardiac Electrophysiology
Background:
- Aortic valve replacement (AVR) is a common procedure.
- Postoperative cardiac conduction abnormalities can occur after AVR.
Purpose of the Study:
- To investigate the pathology of the cardiac conduction system in patients who died within 30 days of AVR.
- To identify causes and risk factors for conduction system injury during AVR.
Main Methods:
- A pathologic study of the cardiac conduction system was conducted on 57 patients post-AVR.
- Histological examination identified old and recent lesions.
- Correlation with preoperative electrocardiograms and surgical factors was assessed.
Main Results:
- Old lesions were found in 60% and recent lesions in 75% of patients.
- Nontraumatic recent lesions rarely caused conduction issues.
- Traumatic lesions, primarily from sutures, were frequently associated with loss of sinus mechanism.
- Bicuspid aortic valves were associated with more traumatic lesions than tricuspid valves.
Conclusions:
- Suture-related trauma is a significant cause of cardiac conduction system injury during AVR.
- The short membranous septum is a predisposing factor for injury.
- Patients with bicuspid aortic valves are at higher risk for conduction system trauma.