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

• Published in: Journal of cardiovascular electrophysiology Vol. 33; no. 4; pp. 575 - 585
• Main Authors: Ghodsi, Saeed, Masoudkabir, Farzad, Hosseini, Zahra, Davarpasand, Tahereh, Yavari, Negin, Mohebi, Mehrnaz, Talasaz, Azita H., Jalali, Arash, Ahmadi‐Tafti, Seyed H., Bagheri, Jamshid, Hasanzadeh, Hakimeh
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2022
• Subjects: 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; dexamethasone; pacemaker; recovery; valvular surgery; atrioventricular block; steroid
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.15378

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.