Incidence and risk factors for pacemaker implantation following aortic valve replacement.
Our aim was to identify the predictive factors for permanent pacemaker (PM) implantation in patients undergoing isolated aortic valve replacement (AVR). A total of 3534 patients received an AVR between January 1990 and December 2003 in our institution. Permanent PM implantation was performed in 234 (6.6%) patients, over median time of three days (range one to 24 days). This patient population was compared to a random sample of 191 patients undergoing AVR without permanent PM implantation. The overall mean age was 63.5 years (±14.2) and 261 patients (62%) were male. Univariate and multivariate logistic regression analysis of pre- and perioperative data were performed. Overall the 30 days mortality was 4.2% (10/234) in patients with PM and 1% (2/191) in the control group (P=0.046). Patients with PMs were older (P<0.001), had more additional coronary artery bypass grafting (CABG) surgery or mitral valve replacement (MVR) (P<0.001), complete right bundle branch block (RBBB) prior to surgery, and more frequently underwent re-operations compared to patients without PMs (P<0.001). The multivariate logistic regression model with PM implantation as the dependent variable demonstrated that older age was not independently associated with PM implantation. As independent predictors concomitant severe mitral valve insufficiency, CABG, subaortic stenosis (SAS) or re-do operations were identified.
Schurr
Ulrich P
UP
Department of Cardiac Surgery, Triemli Hospital, and Biostatistics Unit ISPM, University of Zürich, Birmensdorferstrasse 497, 8063 Zürich, Switzerland. Ulrich.Schurr@triemli.stzh.ch
Berli
Jens
J
Berdajs
Denis
D
Häusler
Achim
A
Dzemali
Omer
O
Emmert
Maximilian
M
Seifert
Burkhardt
B
Genoni
Michele
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult