학술논문

Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial.
Document Type
Article
Source
Journal of Cardiovascular Electrophysiology. Apr2022, Vol. 33 Issue 4, p575-585. 11p. 2 Diagrams, 4 Charts, 1 Graph.
Subject
*Heart valve surgery
*Cardiac surgery
*Length of stay in hospitals
*Intensive care units
*Intravenous therapy
*Dexamethasone
*Convalescence
*Surgical complications
*Heart block
*Treatment effectiveness
*Randomized controlled trials
*Comparative studies
*Descriptive statistics
*Statistical sampling
*Cardiac pacemakers
*Patient safety
*Evaluation
Language
ISSN
1045-3873
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. [ABSTRACT FROM AUTHOR]