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The increased need for a permanent pacemaker after reoperative cardiac surgery
J W Lewis1, C R Webb, S D Pickard
1Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, Detroit, Mich 48202, USA.
The Journal of Thoracic and Cardiovascular Surgery
|July 22, 1998
Summary
Repeat cardiac surgery patients have a higher need for permanent pacemakers (9.7%). Key factors include valve replacement, endocarditis, multiple reoperations, older age, and hypothermia during surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Permanent pacemaker implantation is uncommon after initial cardiac surgery (<3%).
- Repeat cardiac operations present unique challenges and potential complications.
Purpose of the Study:
- To determine the incidence of permanent pacemaker implantation after repeat cardiac surgery.
- To identify factors associated with the need for permanent pacemakers in this patient population.
Main Methods:
- Retrospective study of 558 patients undergoing at least one repeat cardiac operation.
- Univariable and multivariable analyses of clinical, preoperative, and operative data were performed.
Main Results:
- 9.7% of patients required a permanent pacemaker.
- Multivariable analysis identified tricuspid valve surgery, aortic/mitral valve replacement, preoperative endocarditis, number of reoperations, hypothermia, and advanced age as significant factors.
- No significant difference in long-term survival or functional status was observed between patients who did and did not receive a pacemaker.
Conclusions:
- The incidence of permanent pacemaker need is significantly higher after repeat cardiac surgery compared to primary operations.
- Specific surgical factors and patient comorbidities increase the risk of pacemaker implantation.
- Pacemaker requirement after repeat cardiac surgery does not appear to negatively impact long-term outcomes.