Pacemaker implantation within 30 days of surgical AVR yields
Get authentic, real-time news that helps you fight COVID-19 better.
Install PlexusMD App for doctors. It's free.
Among nearly 25,000 Swedish patients who received surgical aortic valve replacement, permanent pacemaker implantation within the first 30 days of the procedure increased risk for all-cause mortality and HF hospitalization.

Prior studies investigating the long-term clinical outcomes of patients who have undergone permanent pacemaker implantation after aortic valve replacement reported conflicting results.

This study aimed to investigate long-term outcomes after primary surgical aortic valve replacement among patients who underwent postoperative permanent pacemaker implantation.

This cohort study included all patients who underwent surgical aortic valve replacement in Sweden from 1997 to 2018. All patients who underwent primary surgical aortic valve replacement in Sweden and survived the first 30 days after surgical treatment were included. Patients who underwent preoperative permanent pacemaker implantation, concomitant surgical treatment for another valve, or emergency surgical treatment were excluded. Patients who underwent concomitant coronary artery bypass grafting or surgical treatment of the ascending aorta were included. Follow-up data were complete for all patients.

Patients underwent implantation of a permanent pacemaker or implantable cardioverter defibrillator within 30 days after aortic valve replacement.

Results:
-- Among 24?983 patients who underwent surgical aortic valve replacement, 849 patients (3.4%) underwent permanent pacemaker implantation within 30 days after surgical treatment and 24?134 patients (96.6%) did not receive pacemakers in that time.

-- The mean age of the total study population was 69.7 years, and 9209 patients were women. The mean and maximum follow-up periods were 7.3 years and 22.0 years, respectively.

-- At 10 years and 20 years after surgical treatment, the Kaplan-Meier estimated survival rates were 52.8% and 18.0% in the pacemaker group, respectively, and 57.5% and 19.6% in the nonpacemaker group, respectively.

-- All-cause mortality was statistically significantly increased in the pacemaker group compared with the nonpacemaker group, and so was risk of heart failure hospitalization.

-- No statistically significant increase was found in the risk of endocarditis in the pacemaker group.

Conclusively, this study found that there were increased risks of all-cause mortality and heart failure hospitalization among patients who underwent permanent pacemaker implantation after surgical aortic valve replacement, suggesting that these risks are important considerations, especially in an era when transcatheter aortic valve replacement is used in younger patients at lower risk of adverse surgical outcomes. These findings further suggest that future research should investigate how to avoid permanent pacemaker dependency after surgical and transcatheter aortic valve replacement.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781927
Like
Comment
Share