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. 2021 Jun 16:7:157-164.
doi: 10.1016/j.xjon.2021.06.005. eCollection 2021 Sep.

Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes

Valentino Bianco  1 , Arman Kilic  1   2 , Edgar Aranda-Michel  1 , Derek Serna-Gallegos  1 , Courtenay Dunn-Lewis  1 , Shangzhen Chen  2 , Floyd Thoma  2 , Forozan Navid  1   2 , Ibrahim Sultan  1   2
Affiliations

Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes

Valentino Bianco et al. JTCVS Open. .

Abstract

Background: Permanent pacemaker placement (PPM) is associated with morbidity following cardiac surgery. This study identified associations between PPM placement and 5-year outcomes for patients that require PPM following valvular surgery.

Methods: All patients who underwent valvular surgery at our medical center from 2011 to 2018 were considered for analysis. Multivariable analysis identified associations between PPM placement, mortality, and readmissions. Primary outcomes were operative complications and mortality. Secondary outcomes included 5-year survival and readmission.

Results: A total of 175 (4.86%) of 3602 valvular surgery patients required postoperative PPM. The PPM cohort had significantly worse baseline comorbidities, including greater Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores (3.8 vs 2.4 P < .0001). The PPM cohort had greater rates of blood product transfusion, prolonged ventilation, and new-onset atrial fibrillation. PPM placement was significantly associated with third-degree heart block (5.26; 95% confidence interval [95% CI], 1.00-27.53; P = .0496), ventricular fibrillation/tachycardia (3.90; 95% CI, 1.59-9.59; P = .01), and atrial fibrillation/flutter (1.53; 95% CI, 1.05-2.24; P = .03). On Kaplan-Meier estimates, 5-year survival (68.8% vs 83.1%; P = 01) was significantly reduced in the PPM cohort. Five-year all-cause readmission (60.4% vs 50.04%; P = .01) and heart failure readmission (35.5% vs 20.1%; P < .000) occurred more frequently in the PPM cohort. On multivariable Cox regression analysis, PPM placement (hazard ratio, 1.12; 95% CI, 0.84-1.50; P = .444) was not an independent predictor of mortality. On competing risk analysis, PPM (hazard ratio, 1.33; 95% CI, 0.99-1.80; P = .062) was not a predictor of hospital readmission.

Conclusions: Valvular surgery patients who required postoperative PPM had elevated baseline operative risk. However, PPM implantation was not associated with mortality or readmission.

Keywords: CABG, coronary artery bypass grafting; CI, confidence interval; HR, hazard ratio; ICD, implantable cardioverter-defibrillator; PPM, postoperative pacemaker placement; arrythmia; permanent pacemaker (PPM); valve surgery.

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Figures

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Graphical abstract
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On Kaplan–Meier estimates, 5-year survival was significantly reduced in the PPM cohort.
Figure 1
Figure 1
Consolidated Standards of Reporting Trials diagram of participant inclusion and exclusion from the investigation. PPM, Permanent pacemaker placement.
Figure 2
Figure 2
On Kaplan–Meier estimates, 5-year survival (68.8% vs 83.1%; P = .001) was significantly reduced in the PPM cohort among patients who underwent isolated valve surgery and coronary artery bypass grafting with valve surgery. PPM, Permanent pacemaker placement.
Figure 3
Figure 3
Adjusted overall survival in the nonpacemaker and PPM cohort among patients who underwent isolated valve surgery and coronary artery bypass grafting with valve surgery. PPM, Permanent pacemaker placement.
Figure 4
Figure 4
Five-year all-cause readmission (60.4% vs 50.0%; P = .010) was significantly higher in the PPM cohort among patients who underwent isolated valve surgery and coronary artery bypass grafting with valve surgery. PPM, Permanent pacemaker placement.
Figure 5
Figure 5
Heart failure readmission (35.5% vs 20.1%; P < .000) occurred more frequently in the PPM cohort among patients who underwent isolated valve surgery and coronary artery bypass grafting with valve surgery. PPM, Permanent pacemaker placement.
Figure 6
Figure 6
Study design and outcomes.
See this image and copyright information in PMC

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