title: Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement.
abstract: BACKGROUND
  The aim of this study was to evaluate the frequency of requirement for permanent pacing and related risk factors after aortic valve replacement.
  
  
  METHODS
  Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 +/- 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%.
  
  
  RESULTS
  Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors.
  
  
  CONCLUSIONS
  Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension.
authors: Kosuyolu Heart and Research Hospital, Department of Cardiovascular Surgery, Istambul, Turkey.
authors: Hasan Basri
authors: HB
authors: Erdogan
authors: Nihan
authors: N
authors: Kayalar
authors: Hasan
authors: H
authors: Ardal
authors: Suat Nail
authors: SN
authors: Omeroglu
authors: Kaan
authors: K
authors: Kirali
authors: Mustafa
authors: M
authors: Guler
authors: Esat
authors: E
authors: Akinci
authors: Cevat
authors: C
authors: Yakut