Key result
The crude incidence of in-hospital permanent pacemaker implantation after surgical aortic valve replacement was 4.0%, with previous cardiac surgery and vasopressor use identified as predictors.
Why the study?
Predictors of permanent pacemaker implantation after surgical aortic valve replacement have mainly been investigated in single-center studies, leaving a need for nationwide data on patient and procedural risk factors.
Cohort (n=5,600)
Yes
In a nationwide Dutch cohort, the incidence of permanent pacemaker implantation after surgical aortic valve replacement was 4.0%, with risk factors including previous cardiac surgery, longer extra-corporeal circulation time, vasopressor use, and conduction abnormalities.
Identifies predictors for PPI risk stratification after SAVR; leaves open whether targeting modifiable factors reduces incidence.
OBJECTIVE: Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. MATERIALS AND METHODS: Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR. RESULTS: From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18-2.76), extra-corporeal circulation time (OR: 1.01; 95% CI: 1.00-1.01), vasopressor use (OR: 2.66; 95% CI: 1.79-3.96) and in-hospital cardiac conduction abnormalities (OR: 4.48; 95% CI: 3.36-5.98) as potential predictors for PPI. Across the time, PPI after SAVR significantly increased (OR: 1.11; 95% CI: 1.03-1.21). CONCLUSIONS: From this nationwide analysis, PPI after SAVR remains a low but increasingly frequent complication. Several predictive factors for postoperative PPI after SAVR have been identified and might be useful for patient informed consent about potential adverse event rate.
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Ravaux et al. (2021) conducted a cohort in symptomatic aortic valve stenosis (n=5,600). Surgical aortic valve replacement (SAVR) was evaluated on in-hospital permanent pacemaker implantation (PPI) during hospitalization after SAVR. The crude incidence of in-hospital permanent pacemaker implantation after surgical aortic valve replacement was 4.0%, with previous cardiac surgery and vasopressor use identified as predictors.
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