Author + information
- Received March 14, 2019
- Revision received August 22, 2019
- Accepted August 25, 2019
- Published online November 18, 2019.
- Gil Moskowitz, BAa,
- Kimberly N. Hong, MDb,
- Gennaro Giustino, MDa,c,
- A. Marc Gillinov, MDd,
- Gorav Ailawadi, MDe,
- Joseph J. DeRose Jr., MDf,
- Alexander Iribarne, MD, MSg,h,
- Alan J. Moskowitz, MDa,
- Annetine C. Gelijns, PhDa and
- Natalia N. Egorova, PhDa,∗ ()
- aDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- bDivision of Cardiovascular Medicine, University of California, San Diego, San Diego, California
- cThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- dDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
- eDivision of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
- fDepartment of Cardiovascular and Thoracic Surgery, Montefiore-Einstein Heart Center, Bronx, New York
- gSection of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- hThe Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- ↵∗Address for correspondence:
Dr. Natalia N. Egorova, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, New York 10029-6574.
Background Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized.
Objectives The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery.
Methods All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State’s mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year.
Results Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM.
Conclusions Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.
- aortic valve
- conduction disorders
- coronary artery bypass grafting
- mitral valve
- permanent pacemaker
- surgical ablation procedure
The data used to produce this publication was purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived, and views expressed herein are those of the author(s) and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here. This work was funded by grant 5U01HL088942 from the National Institutes of Health/National Heart, Lung, and Blood Institute: Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine. The funder did not play any role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. Dr. Ailawadi is a member of Consultant Boards for Abbott, Edwards Lifesciences, Medtronic, and AtriCure. Dr. Gillinov is a consultant to AtriCure, Medtronic, Abbott, CryoLife, Edwards Lifesciences, and ClearFlow; and the Cleveland Clinic has right to royalties from AtriCure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Patrick T. O'Gara, MD, served as Guest Associate Editor for this paper.
- Received March 14, 2019.
- Revision received August 22, 2019.
- Accepted August 25, 2019.
- 2019 American College of Cardiology Foundation
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