Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial

Abstract

Background Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation‐mediated injury might trigger AVB. Methods Patients with advanced postoperative AVB were randomly assigned to receive either dexamethasone (0.4 mg/kg, maximum 30 mg/day) intravenously for 3 days or conservative care only. Primary endpoint was recovery rate in Day 5 since randomization. Secondary endpoints were recovery rate in Day 7 and Day 10, cumulative AVB time, permanent pacemaker (PPM) implantation rate, length of stay in critical care units, and postoperative major adverse events (MAE). Results We enrolled 139 subjects (48.9% male) with mean age of 59.9 years randomly allocated to intervention group (n = 69) and control group (n = 70). Dexamethasone led to higher recovery rates at Day 5 (82.6% vs. 62.9%, p = .009) and Day 7 (88.4% vs. 61.4%, p < .0001) respectively. This benefit ceased at Day 10 (83.05% vs. 78.6%, p = .547). Median cumulative AVB time was shorter in dexamethasone group compared with control group (41 h vs. 64 h, p = .044). PPM implantation rates were similar between the dexamethasone and control groups (15.9% vs. 17.1%, respectively, p = .849). Median length of stay in intensive care unit (ICU) (10 days vs. 12 days, p = .03) and MAE (17.4% vs. 25.7%, p = .133) tended to be lower with dexamethasone. Conclusion Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery.

Effect of acute CORticosteroids on conduction defects after Transcatheter Aortic Valve Implantation: the CORTAVI study

“…Corticosteroids have a potent anti-inflammatory effect mediated by receptors that modulate the expression of inflammatory genes. The high antiedematous activity 11 of these drugs, as demonstrated in previous studies, 12,13 may prevent early conduction disturbances after valve implantation.…”

Pacemakers after valve replacement: Just because we can, should we?

“…In this issue, Ghodsi et al randomize those with AV block after valvular surgery to dexamethasone 4 mg/kg for 3 days or normal care 8 . Steroids, as the authors indicate, have been shown to reduce ischemia‐reperfusion injury, reduce inflammation and edema, and alter molecular/channel effects resulting in enhanced conduction.…”

“…4 In this issue, Ghodsi et al randomize those with AV block after valvular surgery to dexamethasone 4 mg/kg for 3 days or normal care. 8 Steroids, as the authors indicate, have been shown to reduce ischemia-reperfusion injury, reduce inflammation and edema, and alter molecular/channel effects resulting in enhanced conduction. The rationale for this intervention was to hasten the recovery or "unmask" reversibly-injured conduction tissue in hopes of enhancing clinical decisions for PM implantation in the future.…”