Effect of Permanent Pacemaker Implantation After Valve Surgery on Long-Term Outcomes

• Published in: Circulation Journal Vol. 85; no. 7; pp. 1027 - 1034
• Main Authors: Chi, Mu-Chieh, Hung, Kuo-Chun, Chang, Shang-Hung, Wu, Victor Chien-Chia, Chou, An-Hsun, Chan, Yi-Hsin, Lin, Chia-Pin, Chang, Chih-Hsiang, Chu, Pao-Hsien, Chen, Shao-Wei
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.06.2021
• Subjects: Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Humans; Long-term outcome; Pacemaker, Artificial; Permanent pacemaker implantation; Retrospective Studies; Risk Factors; Treatment Outcome; Valve surgery; Long-term outcome; Valve surgery; Permanent pacemaker implantation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-0905

Background:Patients are prone to permanent pacemaker implantation (PPM) after valve surgery, yet current data on the effects of postoperative PPM are scarce and large-scale studies are lacking. The aim of this study was to determine rates and long-term outcomes of PPM after cardiac valve surgery.Methods and Results:A total of 24,014 patients who received valve surgery from 2000 to 2013 were identified from the Taiwan National Health Insurance Research Database. The number of valve surgeries and the proportion of PPM implantations after valve surgery increased (P<0.001). After 1 : 5 propensity score matching, 602 and 3,010 patients were categorized to the PPM and non-PPM groups, respectively. Late outcomes included all-cause mortality, cardiovascular death, sepsis, and readmission due to any cause. The mean follow up was 4.3 years. PPM was associated with a higher all-cause mortality rate (33.6% vs. 29.8%; hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.98–1.32), though not significant at the threshold of P<0.05. PPM was also associated with higher all-cause mortality rates in subgroups that received mitral valve (MV) replacement surgery, combined aortic valve replacement (AVR) with MV surgeries, and combined AVR with tricuspid valve surgeries.Conclusions:The PPM rate after valve surgery is increasing, and is associated with short-term adverse effects. Patients with PPM may have a higher long-term mortality rate.