Key result
Postoperative implantation of a permanent right ventricular pacemaker after mitral valve surgery did not alter the long-term risk of heart failure (HR 1.00; 95% CI 0.78-1.30; P=0.93) or mortality.
Why the study?
Mitral valve surgery frequently leads to reduced postoperative left ventricular ejection fraction, and dyssynchrony from right ventricular pacing may further compromise stroke volume and worsen heart failure risk.
Does right ventricular pacemaker placement alter the long-term risks of heart failure and mortality in patients undergoing mitral valve surgery?
Cohort (n=4,072)
Yes
Does right ventricular pacemaker placement alter the long-term risks of heart failure and mortality in patients undergoing mitral valve surgery?
Hazard Ratio: 1 (95% CI 0.78–1.3)
Absolute Event Rate: 27% vs 22%
p-value: p=0.93
Postoperative implantation of a permanent right ventricular pacemaker does not alter the long-term risks of heart failure and mortality following mitral valve surgery.
Supports safety of right ventricular pacing after mitral valve surgery; leaves open causal effects on heart failure and mortality.
OBJECTIVES: Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. METHODS: Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. RESULTS: Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P = .93 for HF, and .96 (0.76-1.21), P = .72 for mortality. CONCLUSIONS: Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.
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Andersson et al. (2020) conducted a cohort in Mitral valve surgery (n=4,072). Right ventricular pacemaker placement (PPM) vs. No right ventricular pacemaker placement was evaluated on Heart failure (HR 1.00, 95% CI 0.78-1.30, p=0.93). Postoperative implantation of a permanent right ventricular pacemaker after mitral valve surgery did not alter the long-term risk of heart failure (HR 1.00; 95% CI 0.78-1.30; P=0.93) or mortality.
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