Permanent pacemaker implantation after isolated aortic valve replacement: incidence, risk factors and surgical technical aspects

Nardi, Paolo; Pellegrino, A.; Scafuri, Antonio; Bellos, Kyriakos; Propris, Silvia De; Polisca, Patrizio; Chiariello, Luigi

doi:10.2459/jcm.0b013e32832f9fde

Cited by 47 publications

(30 citation statements)

References 20 publications

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“…Rozen et al compared two groups of patients who underwent SAVR, with the only indication for surgery being isolated tricuspid (not bi‐cuspid) aortic valve stenosis, before and after the era of TAVI; they reported a decrease in the EuroSCORE and 30‐day mortality. In our research, during the first period, before the introduction of TAVI, PPM implantation was 3.79%, which is comparable to previous studies; however, in the second period, after the introduction of TAVI, it significantly decreased to 1.47%. Also, the logistic EuroSCORE decreased from 9.6 to 7.5.…”

Section: Discussionsupporting

confidence: 89%

“…Risk factors for the PPM implantation, such as described in previous studies such as preoperative conduction disorders (left bundle branch block, right bundle branch block [RBBB], first-degree atrioventricular block), preoperative myocardial infarction, aortic insufficiency, current smoking, left ventricular ejection fraction <35%, pulmonary hypertension, female sex, preoperative anemia, body mass index ࣙ 28.5 kg/m, 2 bicuspid aortic valve, and cardiopulmonary bypass time ࣙ105 minutes were introduced into the univariate analysis. 4,[7][8][9][10][11][12][13][14][15][16][17][18] In addition, we evaluated the following risk factors: timing periods before and after TAVI program introduction, PVD, diabetes mellitus, standard and logistic EuroSCORE, and age above 75 years. Multivariate stepwise forward logistic regression analysis was then performed with statistically significant univariate predictors in order to find independent predictors for the PPM implantation.…”

Section: Database Management and Statistical Analysismentioning

confidence: 99%

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Permanent Pacemaker Insertion Following Isolated Aortic Valve Replacement before and after the Introduction of TAVI

Kogan

Sternik

Beinart

et al. 2015

Pacing Clinical Electrophis

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Section: Discussionsupporting

confidence: 89%

Section: Database Management and Statistical Analysismentioning

confidence: 99%

Permanent Pacemaker Insertion Following Isolated Aortic Valve Replacement before and after the Introduction of TAVI

Kogan

Sternik

Beinart

et al. 2015

Pacing Clinical Electrophis

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“…The need for a post-operative permanent pacemaker varies greatly (6) and reaches over 30% in some series (2,4). These results are far higher than those found after using the Edwards-Sapien prosthesis (Edwards Lifesciences, Irvine, California) (1) or after surgical aortic valve replacement, which range from 5% to 8% (7). These variations may be partly explained by differences in prosthesis design and implantation technique.…”

mentioning

confidence: 55%

Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System

Muñoz-García

Hernández-García

Jiménez-Navarro

et al. 2012

JACC: Cardiovascular Interventions

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“…While mechanical damage mostly results in a permanent block, haematoma or oedema of the surrounding tissues usually leads to a transient block resolving within a few days. Careful decalcification and cautious suturing in this area may decrease the rate of conduction disturbances [9]. On the other hand, too shallow suturing may result in a perivalvular leak.…”

Section: -Confidence Intervalmentioning

confidence: 99%

Complete atrioventricular block after isolated aortic valve replacement

et al. 2016

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A b s t r a c tBackground: Temporary atrioventricular (AV) conduction disturbances are a common complication following cardiac surgery, especially involving the aortic valve. Permanent complete AV block is a serious and rare complication. Its prevalence has been estimated at 3-6% of all patients undergoing aortic valve replacement. Identification of factors that affect the occurrence of complete AV block requiring permanent pacemaker implantation might help reduce the risk of this problem in the future. Aim:To evaluate clinical, anatomical and surgical factors that might affect occurrence of complete AV, resulting in the need for permanent pacemaker implantation. Methods:In our prospective study, we analysed clinical data of consecutive 159 patients operated due to isolated aortic valve disease between February 2011 and March 2012. Patients with a pacemaker implanted before that time were excluded from the study. The main indication for surgery was aortic stenosis (n = 114, 71.7%). Infectious endocarditis was an indication in 6 (3.8%) cases. Mean patient age was 65.3 ± 11.4 years, and the proportion of males to females was 56.6%/43.4%. Overall, 135 (84.9%) patients had sinus rhythm preoperatively. All operations were performed using median sternotomy, cardiopulmonary bypass, and hypothermia at 30-32°C. A biological prosthesis was implanted in 120 (70.4%) patients. Patients who needed an additional procedure such as another valve surgery, aortic surgery or coronary artery bypass grafting were excluded from the study.Results: Permanent pacemaker implantation was required in 11 (6.9%) patients. The pacemaker was implanted after at least 7 days of complete AV block which was then considered permanent. Univariate analysis showed that permanent pacemaker implantation was associated with prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, and the occurrence of electrolyte disturbances. Univariate logistic regression revealed that the need for permanent pacemaker implantation depended on 5 factors including prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, larger size of the implanted valve prosthesis, endocarditis as the indication for surgery, and electrolyte disturbances. In both backward and forward stepwise multivariate regression models, two parameters, prolonged aortic cross-clamp time and the presence of electrolyte disturbances, correlated with the occurrence of complete AV block. Conclusions:Permanent complete AV block is a serious complication after aortic valve surgery. Of all analysed clinical, anatomical and surgical factors, prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, larger size of the implanted valve prosthesis, endocarditis as the indication for surgery, and electrolyte disturbances were found to be statistically significant predictors of permanent pacemaker implantation.

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Permanent pacemaker implantation after isolated aortic valve replacement: incidence, risk factors and surgical technical aspects

Cited by 47 publications

References 20 publications

Permanent Pacemaker Insertion Following Isolated Aortic Valve Replacement before and after the Introduction of TAVI

Permanent Pacemaker Insertion Following Isolated Aortic Valve Replacement before and after the Introduction of TAVI

Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System

Complete atrioventricular block after isolated aortic valve replacement

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