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Pacemaker Implantation Following Heart Transplantation - Incidence and Risk Factors. Single-Center Experience
Anna Boluk1, Mateusz Sokolski2, Mateusz Rakowski1
1Institute of Heart Disease, Cardiothoracic Surgery Department, University Hospital, Wroclaw, Poland.
Insights
Pacemaker implantation is common after heart transplantation (HTx), particularly with the bicaval technique. Higher donor age and BMI increase the risk of needing a pacemaker post-HTx.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Bradyarrhythmias are frequent complications after orthotopic heart transplantation (HTx).
- Pacemaker (PM) implantation is often required to manage these conduction disorders.
- Current HTx techniques include the bicaval and total heart transplantation methods.
Purpose of the Study:
- To determine the incidence of conduction disorders requiring PM implantation post-HTx.
- To identify risk factors, including donor parameters and surgical techniques, associated with these disorders.
Main Methods:
- A cohort of 111 heart transplant recipients was analyzed.
- Patients were categorized into those requiring PM implantation and those who did not.
- Donor parameters, graft ischemia, transport times, and surgical techniques were compared between groups.
Main Results:
- 9% of HTx patients (10 out of 111) required PM implantation.
- Sinus node dysfunction and complete atrioventricular block were the primary indications for PMs.
- Higher donor age (48 vs. 40 years) and BMI (28 vs. 26 kg/m²) were significantly associated with PM need.
- The bicaval anastomosis technique was used in all PM-requiring patients (100%) versus 70% in the non-PM group (P=0.044).
Conclusions:
- Pacemaker implantation remains a common necessity post-HTx, even with advanced surgical methods.
- The bicaval technique is associated with a higher incidence of bradyarrhythmias requiring pacing.
- Increased donor age and BMI are significant risk factors for PM implantation, relevant given evolving donor heart selection criteria.
Background:
Bradyarrhythmias, requiring pacemaker (PM) implantation, are common complications following orthotopic heart transplantation (HTx). Currently used heart transplantation methods are primarily the bicaval technique and the total heart transplantation technique. The aim of the study was to assess the incidence and risk factors, including donor parameters, of conduction disorders requiring pacing after HTx.
Methods:
A population of 111 (52 ± 13 years, 91 (82%) men) heart recipients was divided into a group requiring PM implantation post-HTx and a group not requiring PM. We compared groups in terms of donor parameters, time of graft ischemia, transport and transplantation, and surgical techniques as the potential risk factors for significant bradyarrhythmias.
Results:
Ten of 111 patients with HTx (9%) required PM implantation. The indication in 7 cases was sinus node dysfunction (SND), in 3 patients it was complete atrioventricular block (AV-block). In the PM group, the age of 48 ± 6 vs 40 ± 11 years (P = .0227) and the body mass index (BMI) 28 ± 3 vs 26 ± 4 kg/m2 (P = .0297) of the donor were significantly higher. There was no influence of organ transport time, ischemia time, and transplantation time. All patients requiring PM implantation were transplanted using the bicaval anastomosis: 10 (100%) vs 71 (70%) in the group not requiring PM (P = .044).
Conclusions:
The need for PM implantation post-HTx despite using new techniques is still common, especially in the group operated with the bicaval method. In addition, higher donor's age and BMI are risk factors of PM implantation, what is of importance as qualification criteria of donor hearts have been gradually extended.
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