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Incidence of permanent pacemaker implantation after valve replacement surgery : Cardiac structure and function at
Jiahui Song1, Zhuo Liang2, Yunlong Wang2
1Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Insights
Permanent pacemaker implantation (PPI) after valve replacement surgery (VR) occurs in 2.42% of patients. Specific procedures like isolated aortic valve replacement increase PPI risk, but long-term cardiac function is generally unaffected.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Permanent pacemaker implantation (PPI) is a potential complication following valve replacement surgery (VR).
- Understanding the incidence and risk factors for PPI is crucial for patient management.
- Assessing the long-term impact of pacemaker dependency on cardiac structure and function post-VR is important.
Purpose of the Study:
- To determine the incidence and identify independent risk factors for PPI after VR.
- To evaluate the influence of long-term pacemaker dependency on cardiac structure and function at one year post-VR.
Main Methods:
- Retrospective analysis of demographic and surgical data from patients undergoing VR (2013-2016).
- Univariate and multivariate analyses to identify predictors of PPI.
- One-year follow-up of patients with complete atrioventricular block (AVB) requiring dual-chamber pacemakers to assess pacemaker dependency and cardiac recovery.
Main Results:
- The overall incidence of postoperative PPI was 2.42% in 5320 VR patients.
- Independent predictors of PPI included isolated aortic valve replacement (AVR), VR with ventricular septal defect (VSD) repair, and VR with aortic root/arch surgery.
- Among survivors requiring pacemakers, 89.6% showed dependency; left atrial and left ventricular dimensions decreased post-PPI, with no significant change in ejection fraction.
Conclusions:
- Isolated AVR, VR with VSD repair, and VR with aortic root/arch surgery are significant predictors of PPI.
- Most patients with AVB after VR do not recover conduction, necessitating pacemaker dependency.
- Pacemaker implantation does not appear to negatively impact cardiac structure and function recovery at one year.
Background:
Our study aimed to explore the incidence and risk factors of permanent pacemaker implantation (PPI) after valve replacement surgery (VR). The influence of long-term pacemaker dependency on cardiac structure and function at the 1‑year follow-up was also assessed.
Methods:
The demographic and surgical data of all consecutive patients who underwent VR between 2013 and 2016 were collected. Univariate and multivariate analyses were performed to identify variables independently associated with PPI after VR. A 1‑year follow-up was undertaken of patients who underwent dual-chambers pacemaker after VR because of complete atrioventricular block (AVB). Long-term pacemaker dependency and recovery of cardiac structure and function were evaluated.
Results:
There were 5320 consecutive patients with VR. The incidence of postoperative PPI was 2.42%. Multivariate analysis indicated that among the 62 patients who underwent PPI due to AVB and sick sinus syndrome, isolated aortic valve replacement (AVR; OR: 2.24, p < 0.05), VR combined with ventricular septal defect (VSD) repair (OR: 6.78, p < 0.05), and VR with aortic root and arch surgery (OR: 4.14, p < 0.05) were independent predictors of PPI after surgery. In total, 89.6% (43/48) of the survivors showed pacemaker dependency. Of these 43 patients, 24 had enlarged left heart before VR. Compared with preoperative values, the left atrial and left ventricular end-diastolic diameter post-PPI decreased significantly, while left ventricular ejection fraction was not significantly different.
Conclusion:
Isolated AVR, VR concomitant with VSD repair, and VR with aortic root and arch surgery are independent predictors of PPI after VR. The majority of patients do not recover from AVB disorders and there is no significant negative effect on recovery of cardiac structure and function.
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