Key result
PPM after SAVR is linked to reduced long-term survival, likely reflecting higher baseline comorbidities.
Why the study?
It is unclear whether permanent pacing after surgical aortic valve replacement independently represents a risk factor for late mortality or merely reflects higher patient complexity and comorbidities.
Does permanent pacemaker implantation after surgical aortic valve replacement impact long-term morbidity and mortality?
Does permanent pacemaker implantation after surgical aortic valve replacement impact long-term morbidity and mortality?
It remains unclear whether permanent pacing after surgical aortic valve replacement is an independent risk factor for late mortality or simply a marker of higher baseline complexity and comorbidities.
Caution against changing post-SAVR pacing thresholds; leaves open whether implantation independently worsens survival or marks higher-risk patients.
Permanent pacing remains a serious complication that can occur in the postoperative period of surgical aortic valve replacement. The reported incidence is variable, and there are many perioperative factors that have been linked with a greater need for permanent pacing. Permanent pacing can also be associated with late lead-related and cardiac complications that can affect late outcome. However, the degree of late dependence on pacemakers is varied, and some studies have shown that a substantial proportion of patients do not need long-term pacing. Some groups have found that permanent pacing was associated with a negative impact on long-term survival in these patients. A common finding among these studies is that the groups of patients with pacemakers had higher preoperative surgical risk and comorbidity status. This makes it difficult to establish whether permanent pacing on its own represents a risk factor for late mortality or whether it is simply a marker that reflects the higher complexity and comorbidities in this group of patients.
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El‐Diasty et al. (2022) conducted a review in Surgical aortic valve replacement requiring permanent pacing. Permanent pacemaker implantation vs. No permanent pacemaker was evaluated on Long-term morbidity and mortality. Permanent pacemaker implantation after surgical aortic valve replacement is associated with reduced long-term survival, though this may reflect higher baseline comorbidities rather than pacing itself.
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