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The effect of myocardial preservation technique on supraventricular tachycardia following aortic valve replacement
1Department of Cardiovascular Surgery, Okayama University Medical School, Japan.
Insights
Aortic valve replacement (AVR) techniques evolved, with improved cooling methods significantly reducing supraventricular tachycardia incidence. Preserving the right atrium during AVR is key to preventing arrhythmias post-surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiology
Background:
- Aortic valve replacement (AVR) is a critical cardiac procedure.
- Supraventricular tachycardias (SVTs) are a known complication following AVR.
- Historical AVR techniques varied in myocardial protection strategies.
Purpose of the Study:
- To compare the incidence of SVTs after isolated AVR using different intraoperative myocardial protection techniques.
- To identify factors influencing SVT occurrence in patients undergoing AVR.
- To evaluate the impact of specific cooling methods on postoperative arrhythmias.
Main Methods:
- Retrospective analysis of 100 patients undergoing isolated AVR between 1974-1991.
- Group A (n=40): Continuous left coronary perfusion with blood (pre-1978).
- Group B (n=60): St. Thomas solution with topical cardiac cooling (post-1979).
- Group B1 (pre-1986): St. Thomas solution with ice slush every 30 min.
- Group B2 (post-1986): St. Thomas solution with cold saline (4°C) and ice slush every 15 min, with emphasis on right atrial cooling.
Main Results:
- SVT incidence: Group A 15%, Group B1 50%, Group B2 15%.
- No correlation found between preoperative factors (NYHA class, valve lesion type, cardiothoracic ratio, LV function, clamp/bypass times, medications) and SVT incidence.
- Enhanced cooling of the right atrium and left ventricle in Group B2 significantly reduced SVT incidence.
Conclusions:
- The evolution of myocardial protection strategies, particularly improved cooling techniques, dramatically impacts postoperative SVT rates after AVR.
- Right atrial preservation and thorough cardiac cooling are crucial for minimizing supraventricular tachycardia incidence following aortic valve replacement.
- Modern AVR protocols should prioritize comprehensive myocardial protection to reduce cardiac arrhythmias.
Abstract:
We studied 100 patients who underwent an isolated aortic valve replacement (AVR) between 1974 and 1991. The patients were divided into the following two groups and compared: group A, which consisted of 40 patients operated on before 1978 who underwent continuous left coronary perfusion with blood; and group B, which consisted of 60 patients operated on after 1979 in whom St. Thomas solution was used in combination with topical cardiac cooling. Moreover, we divided the group B patients into two subgroups: group B1, who underwent AVR before 1986 during which we administered St. Thomas solution with ice slush every 30 min; and group B2, who had AVR after 1986 in which we used St. Thomas solution with a cold saline (4 degrees C) solution and treated with a small amount of slushed ice very 15 min. The incidence of supraventricular tachycardias was 15% in group A, 50% in group B1, and 15% in group B2. The severity of preoperative New York Heart Association (NYHA) functional class, the type of valve lesions, cardiothoracic ratio, left ventricular function, aortic clamp time, bypass time, and use of drugs did not correlate with the incidence of supraventricular tachycardias in either group A or B. In group B2 patients, we paid a lot of attention to cooling the right atrium as well as the left ventricle by immersing the whole heart using a 4 degrees C saline solution, which led to a remarkable reduction of the incidence of supraventricular tachycardia. This fact indicates that right atrial preservation is one of the most important factors for reducing the incidence of supraventricular tachycardia.
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