title: Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience.
abstract: OBJECTIVE
  To identify perioperative clinical predictors of permanent pacemaker implantation following aortic valve replacement.
  
  
  METHODS
  Prospective cohort study on 276 patients submitted for aortic valve replacement: 267 patients (mean (SD) age, 57.5 (14) years) with no conduction disturbances, and nine patients (67.7 (5) years) with severe conduction disturbances requiring permanent pacing; 65 perioperative variables (38 preoperative, eight intraoperative, and 19 postoperative) were considered.
  
  
  RESULTS
  Nine patients (3.2%) had irreversible second or third degree atrioventricular (AV) block requiring permanent pacing. Risk factors for permanent pacing identified by univariate analysis were: preoperative: additional valvar disease, aortic regurgitation, myocardial infarction, pulmonary hypertension, anaemia, use of digitalis; intraoperative: cardiac arrest; postoperative: cardiac arrest, conduction disturbances, electrolytic imbalance, angiotensin converting enzyme inhibitor use. Multivariate logistic regression analysis identified preoperative aortic regurgitation (p < 0.005; odds ratio (OR) 6.6, 95% confidence interval (CI) 1.6 to 12.2), myocardial infarction (p < 0.0005; OR 15.2, 95% CI 6.3 to 19.9), pulmonary hypertension (p < 0.005; OR 12.5, 95% CI 3.2 to 18.3), and postoperative electrolyte imbalance (p < 0.01; OR 4.5, 95% CI 1.3 to 6.4).
  
  
  CONCLUSIONS
  Irreversible AV block requiring permanent pacemaker implantation is an uncommon condition following aortic valve replacement. Previous aortic regurgitation, myocardial infarction, pulmonary hypertension, and postoperative electrolyte imbalance should be considered in order to identify patients at increased risk for advanced AV block.
authors.affiliation: Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. limongelligiuseppe@libero.it
authors.forename: G
authors.initials: G
authors.lastname: Limongelli
authors.forename: V
authors.initials: V
authors.lastname: Ducceschi
authors.forename: A
authors.initials: A
authors.lastname: D'Andrea
authors.forename: A
authors.initials: A
authors.lastname: Renzulli
authors.forename: B
authors.initials: B
authors.lastname: Sarubbi
authors.forename: M
authors.initials: M
authors.lastname: De Feo
authors.forename: F
authors.initials: F
authors.lastname: Cerasuolo
authors.forename: R
authors.initials: R
authors.lastname: Calabrò
authors.forename: M
authors.initials: M
authors.lastname: Cotrufo
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001919:Bradycardia / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006327:Heart Block / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors