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Prognostic impact of 1-year permanent pacemaker implantation after mitral valve surgery with the Cox-maze procedure

Jun Ho Lee1, Yun Jin Kim2,3, Ji Eon Kim1

  • 1Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 29, 2025
PubMed

Insights

Permanent pacemaker (PPM) implantation after mitral valve surgery with the Cox-maze procedure does not increase mortality or stroke risk. However, PPM is linked to a higher risk of infective endocarditis (IE).

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Devices

Background:

  • Mitral valve (MV) surgery combined with the Cox-maze procedure is a common treatment for atrial fibrillation.
  • The need for permanent pacemaker (PPM) implantation post-surgery can impact patient outcomes.
  • Understanding the long-term prognostic implications of PPM is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate the prognostic impact of early permanent pacemaker (PPM) implantation after mitral valve (MV) surgery with the Cox-maze procedure.
  • To assess the association of PPM with long-term overall mortality, infective endocarditis (IE), and ischaemic stroke.
  • To determine the safety and efficacy of the Cox-maze procedure in conjunction with potential PPM needs.

Main Methods:

  • Retrospective cohort study utilizing South Korean National Health Insurance Service (NHIS) data (2005-2020).
  • 10,127 patients undergoing MV surgery with Cox-maze procedure were analyzed.
  • Patients were grouped into PPM (implanted within 1 year) and non-PPM groups; statistical analysis included Cox proportional hazards regression and Fine-Gray competing risk models.

Main Results:

  • 1.76% of patients required PPM implantation.
  • No significant difference in overall mortality or ischaemic stroke risk was observed between PPM and non-PPM groups.
  • PPM implantation was significantly associated with an increased risk of infective endocarditis (HR: 2.015, P=0.010).

Conclusions:

  • Early PPM implantation following MV surgery with the Cox-maze procedure does not adversely affect long-term mortality or stroke risk.
  • A notable increase in the risk of infective endocarditis is associated with PPM implantation.
  • The Cox-maze procedure remains a recommended option for patients with atrial fibrillation undergoing MV surgery.
Abstract

Keywords:
Cox-maze procedureInfective endocarditisIschaemic strokeMitral valve surgeryOverall mortalityPermanent pacemaker implantation

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