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Published on: February 28, 2012
Risk of Permanent Pacemaker Implantation Following Bentall Operation
Michaela Kluckner1, Florian Enzmann1, Leonhard Gruber2
1Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
Insights
Permanent pacemaker dependency is a frequent complication after Bentall operations, affecting 21% of patients within ten years. Early and late pacemaker implantation rates and associated risk factors were investigated in this study.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Conduction disorders are common after cardiac surgery, with permanent pacemaker dependency rates up to 5%.
- Long-term data on pacemaker implantation after Bentall operations are limited.
Purpose of the Study:
- To investigate early and late permanent pacemaker implantation rates following Bentall operations.
- To identify risk factors associated with pacemaker dependency after Bentall procedures.
- To analyze the long-term outcomes of patients requiring pacemakers post-Bentall operation.
Main Methods:
- Retrospective analysis of 260 patients undergoing Bentall operations (including endocarditis and aortic dissection) between March 1996 and December 2015.
- Median follow-up duration of 60 months (range: 12-107 months).
- Investigation of early (30-day) and late pacemaker implantation rates and associated risk factors.
Main Results:
- 31.9% of patients received permanent pacemakers postoperatively, with a 30-day incidence of 7.7%.
- After ten years, 21% of patients were pacemaker dependent.
- Risk factors for pacemaker dependency included advanced age (>75 years), preoperative conduction disturbances, aortic valve stenosis, infective endocarditis, tricuspid valve reconstruction, sepsis, and non-cardiac reoperation.
- Pacemaker implantation significantly increased initial hospitalization length (13 vs 8 days).
- No significant difference in long-term mortality between groups.
Conclusions:
- Permanent pacemaker dependency is a frequent short- and long-term complication after Bentall operations.
- Screening for cardiac conduction disturbances is recommended during short- and long-term follow-up.
- Identifying risk factors can aid in patient selection and management strategies.
Abstract:
Conduction disorders following cardiac surgery are common complications with incidences of permanent pacemaker dependency up to 5%. However, data on pacemaker implantation rates in the long-term follow-up after Bentall operations are scarce. In a retrospective study, a mixed cohort of 260 patients including endocarditis and aortic dissection undergoing Bentall operation between March 1996 and December 2015 was analyzed. Median follow-up time was 60 (12-107) months. Early and late rates of permanent pacemaker implantation and associated risk factors were investigated. In the postoperative course 31 (11.9%) permanent pacemakers were implanted. The 30-day incidence of pacemaker implantations was 7.7% with operations performed after a median of 6 (3-12) days after the Bentall operation. After ten years, 21% of the Bentall patients were permanent pacemaker dependent. The risk factors for permanent pacemaker dependency included age above 75 years (16.1% vs 5.7%; P < 0.001), preoperative cardiac conduction disturbance (32.3% vs 22.7%, P = 0.018), aortic valve stenosis (38.7% vs 23.1, P = 0.008), infective endocarditis (19.4% vs 7.4%, P = 0.004), tricuspid valve reconstruction (6.5% vs 0.9%, P = 0.033), sepsis (12.9% vs 4.4%, P < 0.001) and non-cardiac reoperation (19.4% vs 8.7%, P = 0.004). Pacemaker implantation significantly increased the length of initial hospitalization (13 [8-26] days vs 8 [7-13] days; P = 0.003). In the long-term follow-up, mortality was not different between the groups. Permanent pacemaker dependency is a frequent complication in the short- and long-term follow-up after Bentall operations. Screening for cardiac conduction disturbances in the short- and long-term follow-up is recommended.
