Key result
Age ≥70 solely predicts permanent pacemaker insertion after mitral valve surgery, regardless of atrial access.
Why the study?
It was unknown whether the type of atrial access to the mitral valve or the origin of the sinoatrial node artery influenced postoperative permanent pacemaker implantation.
Does the type of atrial access or origin of the sinoatrial node artery affect the rate of permanent pacemaker insertion in patients undergoing mitral valve surgery?
Cohort (n=469)
No
Does the type of atrial access or origin of the sinoatrial node artery affect the rate of permanent pacemaker insertion in patients undergoing mitral valve surgery?
The type of atrial access and the origin of the SA node artery do not influence the risk of requiring a permanent pacemaker after mitral valve surgery.
Atrial access type and SA node artery origin showed no association with pacemaker implantation after mitral surgery; leaves open whether randomized data would alter practice.
BACKGROUND AND AIM OF THE STUDY: To determine whether the type of atrial access to the mitral valve (left atriotomy, superior trans-septal, or limited trans-septal) influenced postoperative permanent pacemaker implantation and to investigate the effect of the sinoatrial (SA) node artery origin (right coronary or circumflex arteries) on the rate of pacemaker insertion. METHODS: We retrospectively reviewed consecutive cases of patients who had mitral valve surgery at the Trent Cardiac Centre (2008-2016). The primary outcome was the incidence of permanent pacemaker insertion. The data were analyzed using univariate then binary multivariate regression analysis. RESULT: Four hundred sixty nine patients had mitral valve surgery. The mean age was 66.5 ± 12.3 years and 47.5% were female. One hundred fifty patients (32%) had mitral valve surgery via the standard left atriotomy approach, while 226 (48.2%) and 93 (19.8%) cases were performed using the limited trans-septal and superior trans-septal approaches, respectively. Concomitant tricuspid valve surgery was carried out in 33 cases (7%). The overall rate of pacemaker implantation was 5.3%. On univariate analysis, only age (≥70 years old) and concomitant tricuspid valve surgery were significant predictors of postoperative pacemaker insertion, while on multivariate analysis only age (≥70 years old) remained as a predictor. The type of atrial incision and the origin of the SA node artery did not affect the rate of pacemaker implantation. CONCLUSION: The type of atrial approach to the mitral valve and the origin of the SA node artery did not influence the incidence of postoperative permanent pacemaker insertion.
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Boulemden et al. (2019) conducted a cohort in Mitral valve surgery (n=469). Type of atrial access and origin of the sinoatrial node artery vs. Standard left atriotomy approach was evaluated on Incidence of permanent pacemaker insertion. Age ≥70 years was the only independent predictor of permanent pacemaker insertion (overall rate 5.3%) after mitral valve surgery; atrial access type and SA node artery origin had no effect.
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