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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

Marie Claes‡   *
1   Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
,
Francesco Pollari‡   *
1   Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
,
Hazem Mamdooh
1   Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
,
Theodor Fischlein
1   Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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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

Note

A part of the work presented in the current study was achieved in the framework of the following diploma thesis: M. Claes (2022). Hidden pitfalls? Risk of atrioventricular block following surgical aortic valve replacement: A computed tomographic analysis of baseline characteristics. (Unpublished diploma thesis). Paracelsus Medizinische Privatuniversität, Nürnberg.


Authors' Contribution

All authors have read and approved the final version of the manuscript. M.C. and F.P. contributed equally to the article. M.C. provided the data analysis and interpretation as well as the drafting of the article. F.P. designed the study and critically revised the article.


* These authors contributed equally to this work and should be considered as co-first authors.




Publication History

Received: 30 August 2022

Accepted: 09 March 2023

Accepted Manuscript online:
13 March 2023

Article published online:
26 April 2023

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