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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Permanent pacemaker implantation after isolated aortic valve replacement: incidence, indications, and predictors.
Sam Dawkins1, Alex R Hobson, Paul R Kalra
1Wessex Cardiac Unit, Southampton University Hospital, Southampton, United Kingdom.
The Annals of Thoracic Surgery
|December 25, 2007
Summary
Permanent pacemaker implantation (PPM) is common after aortic valve replacement, especially with pre-existing conducting system disease. Patients with preoperative conducting system disease or aortic regurgitation face higher risks for PPM.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Aortic valve disease frequently coexists with conduction abnormalities.
- Aortic valve replacement (AVR) can precipitate further conduction issues, potentially requiring permanent pacemaker implantation (PPM).
- Understanding early PPM incidence and predictors post-AVR is crucial for patient management.
Purpose of the Study:
- To determine the contemporary incidence of early postoperative PPM in patients undergoing isolated AVR.
- To identify predictors associated with the need for PPM following AVR.
Main Methods:
- Analysis of 354 consecutive patients undergoing isolated AVR over 30 months.
- Exclusion of patients with unavailable data or prior PPM (n=12).
- Evaluation of 342 patients (mean age 67 years, 62% male) with indications including stenosis, regurgitation, and endocarditis.
Main Results:
- In-hospital mortality was 1.8%.
- 8.5% of patients (29 of 342) required early PPM, predominantly during the initial hospital stay.
- Preoperative conducting system disease (16% vs 6%, p=0.004) and valvular regurgitation (16% vs 7%, p=0.01) were associated with increased PPM need. Preoperative conducting system disease independently predicted PPM (RR 2.88, 95% CI 1.31-6.33).
Conclusions:
- Permanent pacemaker implantation is a frequent complication after aortic valve replacement.
- Preexisting conduction abnormalities and preoperative aortic regurgitation are significant predictors of PPM requirement.
- Discussing the risk of PPM is essential during the preoperative consent process for AVR.
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