Permanent cardiac pacing following surgery for acquired valvular disease

Between January 1980 and January 1998, implantation of a permanent pacemaker (PP) was performed in 22 patients (6.7%) following 327 acquired valvular surgeries. The indications for implantation of a PP were bradycardia with atrial fibrillation in 12 cases, sick sinus syndrome in 7 cases and complete atrioventricular block in 3 cases. These patients received an implantation after surgery for mitral valvular disease in 14 cases, aortic valvular disease in 3 cases and combined valvular disease in 5 cases. These cases were also concomitant with a tricuspid valve annuloplasty in 6 cases for secondary regurgitation and with a maze procedure in 4 cases. For the purpose of this study, these patients were compared to patients who did not require implantation of a PP after surgery. Univariate analysis showed the significant factors to be female gender (p = 0. 041), preoperative atrial fibrillation (p = 0.013), redo cardiac surgery (p < 0.0001), and the use of blood cardioplegia (p = 0.003). There were no differences in valvular disease, age at the last valvular operation, addition of tricuspid valve annuloplasty, extracorporeal circulation times, or aortic cross-clamp times between those patients with and those without PP. Among these factors, logistic regression analysis showed female gender, redo surgery and the use of blood cardioplegia to be more significant predictors for the requirement of PP after acquired valvular disease operation. Maze procedure was not a significant predictor for the requirement of PP after surgery.