scholarly journals Significance of Ectopic Beats in Post Aortic Valve Replacement Arrhythmia Patients

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Issam Damin Nayef Alhamaideh ◽  
Tariq Emad Hawash Al-Bkoor ◽  
Adnan Tahir
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
De Novo ◽  
Common Finding ◽  
Conduction Delay ◽  
Surgical Aortic Valve Replacement ◽  
Intraventricular Conduction ◽  
Risk Patients ◽  
Premature Beats

Objective: The incidence of new onset arrhythmia after conventional aortic valve replacement (AVR) is relatively high whereby atrial fibrillation (AF) in particular (30-40%). Arrhythmias increase postoperative morbidity, mortality and consequently health costs. The need for a reliable method for early detection and discrimination between low and high risk patients is therefore indispensable. For this reason this study examined the possible correlation between electrophysiological abnormalities on continuous ECG recordings and the initiation of arrhythmia directly after surgery. Methods and Results: Both ECG and clinical data was collected from the hospitals filing system for all patient (n=107) who underwent surgical Aortic Valve Replacement (AVR) for non-rheumatic aortic valve stenosis or insufficiency for the period from January 2010 to December 2018.  Continuous ECG data was converted into ISHNE-format and analyzed by using Synescope™ software. Data showed that one minute prior to arrhythmia, AF in particular, an increase of both supraventricular premature beats (SVPB) and missed beats (MB) was detected (n=33; P<0,05). However there was no correlation between arrhythmia and the overall SVPB incidence (n=33). Twenty-one out of 33 AVR patients developed a de novo intraventricular conductance delay directly after cardioplegic arrest, which persisted in 7 cases. Conclusions: Although there is an increase of both SVPB and MB prior to arrhythmia startup, it is still questionable what is the true predictive value of these findings are. Additionally it appeared that a temporarily intraventricular conduction delay (IVCD) is a common finding after AVR.

scholarly journals The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

2021 ◽  
pp. 155698452097831
Author(s):  
Vinod H. Thourani ◽  
J. James Edelman ◽  
Sari D. Holmes ◽  
Tom C. Nguyen ◽  
John Carroll ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Early Mortality ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Risk Patients

Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

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