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

Saeed Ghodsi, Farzad Masoudkabir, Zahra Hosseini, Tahereh Davarpasand, Negin Yavari, Mehrnaz Mohebi, Azita H Talasaz, Arash Jalali, Seyed H Ahmadi-Tafti, Jamshid Bagheri, Hakimeh Hasanzadeh

Journal of cardiovascular electrophysiology 2022 Apr

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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. © 2022 Wiley Periodicals LLC.

Citation

Saeed Ghodsi, Farzad Masoudkabir, Zahra Hosseini, Tahereh Davarpasand, Negin Yavari, Mehrnaz Mohebi, Azita H Talasaz, Arash Jalali, Seyed H Ahmadi-Tafti, Jamshid Bagheri, Hakimeh Hasanzadeh. Steroid Use for Recovery of advanced atrioVentricular block Immediately after VALvular surgery (SURVIVAL): A preliminary randomized clinical trial. Journal of cardiovascular electrophysiology. 2022 Apr;33(4):575-585