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Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and

Mark R Helmers1, Max Shin1, Amit Iyengar1

  • 1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 4, 2021
PubMed
Abstract

Insights

Permanent pacemaker (PPM) implantation after mitral valve surgery (MVS) is linked to older age and additional procedures. While PPM is associated with survival, it does not independently predict mortality.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Electrophysiology

Background:

  • Permanent pacemaker (PPM) implantation is a known complication of valvular surgery.
  • PPMs carry risks including infection, tricuspid valve regurgitation, and pacing-induced cardiomyopathy.
  • Limited literature exists on PPM placement specifically in mitral valve surgery (MVS).

Purpose of the Study:

  • To identify predictors of PPM implantation following MVS.
  • To assess the association between PPM implantation and long-term survival after MVS.

Main Methods:

  • Retrospective review of adult patients undergoing MVS from 2011-2019.
  • Stratification based on PPM receipt post-surgery; exclusion of patients with preoperative PPM.
  • Multivariable logistic regression and Cox proportional hazards models were used to identify risk factors and survival associations.

Main Results:

  • Significant predictors for PPM included increasing age, concomitant aortic and tricuspid valve procedures, and prior myocardial infarction.
  • In isolated MV repair, annuloplasty with a ring prosthesis increased PPM risk compared to a band.
  • No significant survival difference was found, and PPM was not an independent predictor of mortality.

Conclusions:

  • Increasing age and concomitant procedures are key predictors for PPM implantation in MVS.
  • PPM implantation is associated with worse long-term survival but does not independently predict mortality.
  • Annuloplasty ring use in isolated MV repair is linked to higher PPM rates.
Keywords:
Mitral valve repairMitral valve surgeryPermanent pacemakerSurvival analysis

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