TY - JOUR
T1 - Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery
AU - Moskowitz, Gil
AU - Hong, Kimberly N.
AU - Giustino, Gennaro
AU - Gillinov, A. Marc
AU - Ailawadi, Gorav
AU - DeRose, Joseph J.
AU - Iribarne, Alexander
AU - Moskowitz, Alan J.
AU - Gelijns, Annetine C.
AU - Egorova, Natalia N.
N1 - Funding Information:
The data used to produce this publication was purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived, and views expressed herein are those of the author(s) and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here. This work was funded by grant 5U01HL088942 from the National Institutes of Health/National Heart, Lung, and Blood Institute: Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine. The funder did not play any role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr. Ailawadi is a member of Consultant Boards for Abbott, Edwards Lifesciences, Medtronic, and AtriCure. Dr. Gillinov is a consultant to AtriCure, Medtronic, Abbott, CryoLife, Edwards Lifesciences, and ClearFlow; and the Cleveland Clinic has right to royalties from AtriCure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Patrick T. O'Gara, MD, served as Guest Associate Editor for this paper.
PY - 2019/11/26
Y1 - 2019/11/26
N2 - Background: Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. Objectives: The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. Methods: All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. Results: Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. Conclusions: Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.
AB - Background: Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. Objectives: The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. Methods: All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. Results: Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. Conclusions: Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.
KW - aortic valve
KW - conduction disorders
KW - coronary artery bypass grafting
KW - mitral valve
KW - permanent pacemaker
KW - surgical ablation procedure
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U2 - 10.1016/j.jacc.2019.08.1064
DO - 10.1016/j.jacc.2019.08.1064
M3 - Article
C2 - 31753204
AN - SCOPUS:85074499998
VL - 74
SP - 2607
EP - 2620
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 21
ER -