Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Device Outcomes

Background:

• Permanent pacemaker (PPM) implantation is often considered a minor complication after transcatheter aortic valve replacement (TAVR).
• The long-term consequences of PPM placement, particularly in the context of TAVR's expansion to lower-risk populations, are not fully understood.

Purpose of the Study:

• To evaluate the long-term outcomes associated with PPM placement following surgical aortic valve replacement (SAVR).
• To assess the impact of PPM on survival rates and resource utilization after SAVR.

Main Methods:

• A retrospective review of 2,600 patients undergoing SAVR over 15 years was conducted.
• Patients were stratified based on PPM placement within 30 days of surgery.
• Long-term survival was analyzed using Kaplan-Meier and Cox proportional hazards modeling, with risk adjustment based on STS predicted risk of mortality.

Main Results:

• 2.7% of patients (72) required PPM implantation post-SAVR.
• PPM patients experienced more postoperative complications (atrial fibrillation, prolonged ventilation, renal failure) and increased resource utilization (longer ICU and hospital stays, higher costs).
• PPM placement was associated with significantly worse long-term survival (p=0.02), even after risk adjustment (HR 1.48, p=0.02).

Conclusions:

• PPM implantation after SAVR independently reduces long-term survival.
• While the rate of PPM placement is low, it significantly increases healthcare resource utilization.
• Close monitoring of PPM's long-term survival impact is essential as TAVR adoption grows in lower-risk patient groups.