Cardiovascular Surgery and Interventions 2023, Vol 10, Num 3 Page(s): 161-169
Conduction system abnormalities after isolated surgical aortic valve replacement

Eray Aksoy, Hasan Sunar

Department of Cardiovascular Surgery, Kartal Koşuyolu Training and Research Hospital, Istanbul, Türkiye

Keywords: Aortic valve replacement, conduction system disturbances, pacemaker, surgery
Objectives: This study aimed to examine the predictive value of preoperative electrocardiogram (ECG) findings for postoperative fascicular and atrioventricular (AV) conduction system defects in patients undergoing surgical aortic valve replacement for isolated aortic stenosis.

Patients and methods: The retrospective study included a total of 74 patients (45 males, 29 females; mean age: 62.9±13.7 years; range, 27 to 82 years) who underwent isolated surgical aortic valve replacement for aortic stenosis between September 2009 and September 2011. Electrocardiogram sheets taken at four time points (before the operation, first postoperative hour, 48th postoperative hour, and before discharge) were evaluated. The primary outcome was the development of AV block of the second or third degree or any type of fascicular conduction defect. The requirement for a temporary or permanent pacemaker during the postoperative stay was a secondary outcome.

Results: Before aortic valve replacement, the three most common ECG findings were left ventricle hypertrophy in 35 (47.3%) patients, T-wave inversion in 29 (39.2%), and left septal fascicular block in 18 (24.2%). None of the study parameters significantly predicted the need for temporary pacemaker requirement after surgery. Patients with preoperative left ventricle hypertrophy (odds ratio [OR]: 2.38, p=0.07), ST segment depression (OR: 3.04, p=0.9), left septal fascicular block (OR: 1.66, 0.34), and right bundle branch block (OR: 4.77, p=0.30) tended to develop postoperative AV block or fascicular block. Preoperative left bundle branch block was the only significant risk for developing advanced conduction disturbances after surgery (OR: 8.60, p=0.009).

Conclusion: The presence of monofascicular, bifascicular, or bundle branch block on the preoperative ECG may predict the likelihood of developing AV block or fascicular conduction system disorders after surgical aortic valve replacement, which should be confirmed in further studies employing continuous ECG monitoring in a larger patient population.

DOI : 10.5606/e-cvsi.2023.1542