Baseline CT-Based Risk Factors for Atrioventricular Block after Surgical AVR

Marie Claes; Francesco Pollari; Hazem Mamdooh; Theodor Fischlein

doi:10.1055/a-2052-8848

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2025; 73(02): 117-125
DOI: 10.1055/a-2052-8848

Original Cardiovascular

Baseline CT-Based Risk Factors for Atrioventricular Block after Surgical AVR

Authors

Marie Claes‡^*

¹Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Francesco Pollari‡^*

¹Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Hazem Mamdooh

¹Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Theodor Fischlein

¹Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany

Abstract

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Abstract

Background We aimed to evaluate the impact of membranous interventricular septum (MIS) length and calcifications of the native aortic valve (AV), via preoperative multidetector computed tomography (MDCT) scan, on postoperative atrioventricular block III (AVB/AVB III) and permanent pacemaker implantation in surgical aortic valve replacement (SAVR).

Methods We retrospectively analyzed preoperative contrast-enhanced MDCT scans and procedural outcomes of patients affected by AV stenosis who underwent SAVR at our center (June 2016–December 2019). The study population was divided into two groups (AVB and non-AVB), and variables were compared with a Mann–Whitney's U-test or chi-square test. Data were further analyzed using point biserial correlation and logistic regression.

Results A total of 155 (38% female) patients (mean age of 71.2 ± 6 years) were enrolled in our study: conventional stented bioprosthesis (N = 99) and sutureless prosthesis (N = 56) were implanted. A postoperative AVB III was observed in 11 patients (7.1%). AVB patients had significant greater calcifications in left coronary cusp (LCC) -AV (non-AVB = 181.0 mm³ [82.7–316.9] vs. AVB = 424.8 mm³ [115.9–563.2], p = 0.044), LCC left ventricular outflow tract (LVOT) (non-AVB = 2.1 mm³ [0–20.1] vs. AVB = 26.0 mm³ [0.1–138.0], p = 0.048), right coronary cusp (RCC) -LVOT (non-AVB = 0 mm³ [0–3.5] vs. AVB = 2.8 mm³ [0–29.0], p = 0.039), and consequently in total LVOT (non-AVB = 2.1 mm³ [0–20.1] vs. AVB = 26.0 mm³ [0.1–138.0], p = 0.02), while their MIS was significantly shorter than in non-AVB patients (non-AVB = 11.3 mm [9.9–13.4] vs. AVB = 9.44 mm [6.98–10.5]; p=0.014)). Partially, these group differences correlated positively (LCC -AV, r = 0.201, p = 0.012; RCC -LVOT, r = 0.283, p ≤ 0.001) or negatively (MIS length, r = −0.202, p = 0.008) with new-onset AVB III.

Conclusion We recommend including an MDCT in preoperative diagnostic testing for all patients undergoing surgical AVR for further risk stratification.

Keywords

aortic valve - preoperative multidetector computed tomography - MDCT scan - surgery - complications

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References

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