Immediate Postoperative Pacing Dependency Is Not Associated With Worse Mid-Term Survival in Redo Mitral Valve Surgery

Risk factors (RF) for permanent pacemaker (PPM) placement in cardiac surgery include valvular operations and redo operations. We aim to identify RF for PPM placement prior to discharge (DC) specifically among redo mitral valvular operations, and to analyze outcomes in this population. Our retrospective review considered 943 patients undergoing redo MV operations between 01/2002 and 12/2021, excluding patients experiencing in-hospital death within 48 hours of their operation and patients with existing PPM or implanted cardiac defibrillator (ICD). Patients (n = 742) were categorized based on whether they received a PPM before DC or not. Of the 742 patients analyzed, 47 (6%) had a PPM placed before DC. Logistic regression analysis identified increasing age, increasing severity of MR (OR: 1.9, p < 0.01), bioprosthetic and mechanical valve implantation (OR: 1.9, p = 0.045), sternotomy incision (OR: 0.12, p = 0.04), and simultaneous tricuspid procedure (OR: 1.9, p = 0.06) as predictors of PPM placement. Cox hazards analysis showed advanced age (HR 1.03, p < 0.01), higher NYHA class (HR 1.45, p < 0.01), DM (HR 1.51, p = 0.01), and prior valve replacement (HR 1.43, p < 0.01) are predictors of mortality, while PPM placement before DC was not. In redo MV surgery, RF for PPM include procedural risks that prolong operative time and increase risk of conduction system injury, including simultaneous tricuspid valve procedures, maximally invasive approaches, and valve replacement, as well as poorer preoperative functional status, advanced age, and medical comorbidities. PPM placement before DC was not predictive of mortality, and did not negatively impact survival in long term follow-up.