Predictors of permanent pacemaker insertion after mitral valve replacement: A systematic review.

Area of Science:

• Cardiovascular Surgery
• Cardiac Electrophysiology

Background:

• Surgical mitral valve replacement (MVR) is evolving with new techniques and access routes.
• Procedure-related complications, including permanent pacemaker (PPM) implantation, require thorough investigation.

Purpose of the Study:

• To identify the incidence and predictors of PPM implantation following MVR.
• To understand the burden of PPM implantation as a complication of MVR.

Main Methods:

• Systematic search of digital databases for studies reporting PPM implantation after MVR.
• Abstraction of study and patient-level data, including sample size, follow-up, PPM rates, and patient demographics.
• Meta-analysis of 12 studies involving 37,124 patients.

Main Results:

• Overall PPM implantation rate was 7.6% (2820/37,124 patients), with a range of 1.7% to 10.96%.
• Atrioventricular (AV) block was the primary indication for PPM, followed by sinoatrial (SA) node dysfunction and bradycardia.
• Predictors for PPM implantation included older age, male gender, comorbid conditions, prior coronary artery bypass grafting (CABG), history of arrhythmias, antiarrhythmic drug use, atrial fibrillation ablation, and double valve replacement.

Conclusions:

• PPM implantation is a significant complication following MVR, occurring in 7.6% of cases.
• Several patient-specific factors and prior interventions are associated with an increased risk of PPM implantation post-MVR.
• Understanding these predictors is crucial for risk stratification and management in patients undergoing MVR.