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Related Experiment Videos

Cardiac pacing and valvular surgery.

D Gaillard1, P Lespinasse, A Vanetti

  • 1Hôpital Saint-Joseph, Paris, France.

Pacing and Clinical Electrophysiology : PACE
|November 1, 1988
PubMed
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Permanent pacemaker implantation during valvular surgery (VS) impacts survival, particularly in older patients with severe cardiac conditions. Myocardial leads offer a simpler approach for uncertain conduction disturbances during VS.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Valvular surgery (VS) can necessitate permanent pacemaker (PPM) implantation.
  • Understanding outcomes for different pacing scenarios during VS is crucial.
  • Aortic disease, particularly calcified aortic stenosis (CAS), is a common indication for VS.

Purpose of the Study:

  • To analyze outcomes of patients undergoing VS with varying relationships to permanent pacing.
  • To compare survival rates and identify factors influencing outcomes in different pacing groups.
  • To evaluate the utility of myocardial lead placement during VS.

Main Methods:

  • Retrospective analysis of 17-year data (1970-1987) on 177 patients undergoing VS.
  • Categorization into four groups based on pacing status relative to VS.

Related Experiment Videos

  • Review of pre-, peri-, and post-operative clinical and electrocardiographic data.

    • Main Results:

    • 75 patients (3%) required PPM at VS (Group 1), with lower survival than overall VS patients due to age and comorbidities.
    • 9 patients (Group 2) were paced long after VS, 5 using a myocardial lead.
    • 12 patients (Group 3) were pre-paced; they were older and had high mortality, especially those operated on 1973-1978.
    • 81 patients (Group 4) had a myocardial lead placed during VS without subsequent need for pacing; lead implantation rates decreased from 10% to 0.5%.

    Conclusions:

    • Permanent pacemaker implantation during VS is associated with specific patient profiles and outcomes.
    • Older patients and those with severe cardiac conditions undergoing VS requiring pacing have poorer survival.
    • Myocardial lead placement during VS may be a simpler strategy for managing uncertain peroperative conduction disturbances, especially in patients with tricuspid disease.