(PACE 2009; 32:7-12) permanent pacemaker, cardiac surgery IntroductionThe incidence of conduction disturbance requiring pacing after open heart operations is between 10% and 15%. [1][2][3][4] Most of these will recover, however, 1-3% of patients will require permanent pacemaker implantation. [5][6][7] We reviewed our experience with permanent pacemaker (PPM) implantation following cardiac surgery. Our aim was to identify predictors for PPM requirement and identify patients who will remain pacemaker dependent over long term.

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Background: The choice between a mechanical or bioprosthetic valve replacement device is not always clear, although patient age is most often the determining factor. We reviewed our experience with patients undergoing aortic valve replacement (AVR) in order to assess and compare long‐term outcomes between patients receiving a mechanical valve and those receiving a bioprosthesis. Methods: Three hundred fifty‐two patients underwent AVR with or without coronary artery bypass between 1993 and2004: 189 received a mechanical valve and 163 a bioprosthesis. Events included: late mortality, thrombo‐embolic events, stroke, bleeding events, valve thrombosis, endocarditis, reoperation, and coronary catheterization. Results: Patients in the bioprosthesis group were older (71 ± 11 vs. 65 ± 13) than in the mechanical group (p < 0.0001). There was no difference in operative mortality (6.8%) or morbidity. Follow‐up (61 ± 40 months) was available in 87%. For mechanical valves and bioprostheses, respectively: 3‐, 5‐, and 10‐year survival was 92%, 86%, and 69% versus 90%, 86%, and 71% (p = n.s.); and event‐free survival was 79%, 68%, and 41% versus 79%, 68%, and 44% (p = n.s.). Five patients (3%) in each group required re‐replacement of their aortic valve (p = n.s.). Coronary artery disease requiring bypass surgery did not affect long‐term survival. Age at operation and renal failure were the only predictors for late mortality. Conclusions: Survival and event‐free survival are similar for patients receiving a mechanical or biological aortic valve substitute. Selection of a valve replacement device should be based on life expectancy, patient preference, ability to take anticoagulants, lifestyle, risk of bleeding, and risk of reoperation. Patient age alone should not be the determining factor.

Strokes after cardiac surgery are mostly right hemispheric and exclusively ischemic. Outcome is relatively fair. We suggest an embolic injury to the right hemisphere, procedure related, as a possible mechanism.

Labor is a bacteriuric event. Iatrogenic interventions can predispose parturients with sterile urine cultures to postpartum bacteriuria.