Bloqueio atrioventricular no pós-operatório de cirurgia cardíaca valvar

Ferrari, Andrés; Sussenbach, Carolina Pelzer; Guaragna, João Carlos Vieira da Costa; Piccoli, Jacqueline da Costa Escobar; Gazzoni, Guilherme Ferreira; Ferreira, Débora Klein; Albuquerque, Luciano Cabral; Goldani, Marco Antônio

doi:10.5935/1678-9741.20110010

Cited by 24 publications

(19 citation statements)

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“…Data in the literature regarding the significance of chronic comorbidities such as chronic renal failure, chronic obstructive pulmonary disease, diabetes mellitus and preoperative arrhythmias as predictors of postoperative pacing are conflicting [14,15,27]. In our study none of the above mentioned comorbidities were significantly associated with the need for TCP in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 46%

“…However, these recommendations are decades old and may not reflect modern surgical techniques and practice. Recent few reports studied the rate and the predictors of TCP after valvular and pediatric cardiac surgeries [15,16,25]. At our center, to avoid the above mentioned complications and in accordance with the published literature, and it is upon surgeon’s discretion to safely select patients, we limited the insertion of PWs in valve surgery (usually based on; young age with minimal comorbidities, uncomplicated single valve surgery, not involving extensive decalcification, and after separation from CPB in sinus rhythm, and hemodynamically stable on minimal support, including recently, patients in sinus bradycardia who responds to minimal doses of beta-adrenergic drugs) (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…However, PWs are routinely inserted after valve and congenital heart surgeries promoted by historical evidence of increased need for temporary cardiac pacing (TCP) in such surgeries [12-14]. Recent limited publications suggest a trend towards selective use [15,16]. Ferrari et al [15] reported TCP in 17% of their valve surgery cases and Gupta et al [16] in 30% of their congenital heart surgery cases.…”

Section: Introductionmentioning

confidence: 99%

“…Recent limited publications suggest a trend towards selective use [15,16]. Ferrari et al [15] reported TCP in 17% of their valve surgery cases and Gupta et al [16] in 30% of their congenital heart surgery cases.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of temporary epicardial pacing wires use after valve surgery

AlWaqfi

Ibrahim

Khader

et al. 2014

J Cardiothorac Surg

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BackgroundAlthough temporary cardiac pacing is infrequently needed, temporary epicardial pacing wires are routinely inserted after valve surgery. As they are associated with infrequent, but life threatening complications, and the decreased need for postoperative pacing in a group of low risk patients; this study aims to identify the predictors of temporary cardiac pacing after valve surgery.MethodsA retrospective analysis of data collected prospectively on 400 consecutive valve surgery patients between May 2002 and December 2012 was performed. Patients were grouped according to avoidance or insertion of temporary pacing wires, and were further subdivided according to temporary cardiac pacing need. Multiple logistic regression was used to determine the predictors of temporary cardiac pacing.Results170 (42.5%) patients did not have insertion of temporary pacing wires and none of them needed temporary pacing. 230 (57.5%) patients had insertion of temporary pacing wires and among these, only 55 (23.9%) required temporary pacing who were compared with the remaining 175 (76.1%) patients in the main analysis. The determinants of temporary cardiac pacing (adjusted odds ratios; 95% confidence interval) were as follows: increased age (1.1; 1.1, 1.3, p = 0.002), New York Heart Association class III- IV (5.6; 1.6, 20.2, p = 0.008) , pulmonary artery pressure ≥ 50 mmHg (22.0; 3.4, 142.7, p = 0.01), digoxin use (8.0; 1.3, 48.8, p = 0.024), multiple valve surgery (13.5; 1.5, 124.0, p = 0.021), aorta cross clamp time ≥ 60 minutes (7.8; 1.6, 37.2, p = 0.010), and valve annulus calcification (7.9; 2.0, 31.7, p = 0.003).ConclusionAlthough limited by sample size, the present results suggest that routine use of temporary epicardial pacing wires after valve surgery is only necessary for high risk patients. Preoperative identification and aggressive management of predictors of temporary cardiac pacing and the possible modulation of intraoperative techniques can decrease the need of temporary cardiac pacing. Prospective randomized controlled studies on a larger number of patients are necessary to draw solid conclusions regarding the selective use of temporary epicardial pacing wires in valve surgery.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of temporary epicardial pacing wires use after valve surgery

AlWaqfi

Ibrahim

Khader

et al. 2014

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…В данных ситуациях требуется лишь временная электро-кардиостимуляция (ЭКС). Однако у 1-3% боль-ных в связи с необратимыми изменениями в проводящей системе сердца возникает необхо-димость имплантации постоянного электрокар-диостимулятора [1].…”

Section: Introductionunclassified