Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial
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...
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| Published in | Journal of cardiovascular electrophysiology Vol. 33; no. 4; pp. 575 - 585 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Wiley Subscription Services, Inc
01.04.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1045-3873 1540-8167 1540-8167 |
| DOI | 10.1111/jce.15378 |
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| 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. |
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| AbstractList | Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB.
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).
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.
Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery. Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB.BACKGROUNDAtrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB.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).METHODSPatients 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).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.RESULTSWe 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.Dexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery.CONCLUSIONDexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery. BackgroundAtrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation‐mediated injury might trigger AVB.MethodsPatients 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).ResultsWe 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.ConclusionDexamethasone may serve as a safe and effective medication to help hasten recovery of advanced AVB after valvular surgery. 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. |
| Author | Yavari, Negin Masoudkabir, Farzad Bagheri, Jamshid Hasanzadeh, Hakimeh Hosseini, Zahra Ahmadi‐Tafti, Seyed H. Talasaz, Azita H. Ghodsi, Saeed Jalali, Arash Mohebi, Mehrnaz Davarpasand, Tahereh |
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Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation‐mediated injury might... Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger AVB.... BackgroundAtrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation‐mediated injury might... Atrioventricular block (AVB) is an important complication following valvular surgery. Several factors including inflammation-mediated injury might trigger... |
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| SubjectTerms | atrioventricular block Atrioventricular Block - diagnosis Atrioventricular Block - etiology Atrioventricular Block - therapy Cardiac Surgical Procedures - adverse effects Dexamethasone Female Heart Heart Valve Diseases - surgery Humans Length of stay Male Middle Aged pacemaker Pacemaker, Artificial Pacemakers Postoperative Complications - etiology recovery steroid Steroids Surgery valvular surgery |
| Title | Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial |
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