Francesca Gatta*, Yama Haqzad, Mahmoud Loubani
Gatta et al. J Clin Transl Res 2021; 7(6):15
Published online: November 29, 2021
Background and aim: This study evaluates whether aortic or mitral valve replacement with biological versus mechanical prostheses are independent risk factors for permanent pacemaker (PPM) post-cardiac surgery, alongside traditionally accepted determinants.
Methods: Single centre 10 years of retrospective activity. Case-control 1-to-9 matching (tolerance of 0.01) for 7 pre-operative and 2 intra-operative factors. Pearson Chi-Square test and one-way ANOVA for qualitative and quantitative analysis, respectively.
Results: After matching, 617 patients were included for analysis: aortic valve replacement, AVR (79.4% n=490) and mitral valve replacement, MVR (20.6% n=127). Permanent pacemaker was implanted in 3.7% (n=18) and 3.1% (n=4), p 0.8, respectively. A further analysis for PPM rate in biological vs mechanical prostheses did not provide any significant result (p 0.6 AVR and p 0.8 MVR). Post-operative complications in AVR and MVR groups were: re-opening (4.5% vs 6.3%, p 0.4), myocardial infarction (0.8% vs 3.2%, p 0.04), pulmonary (32.9% vs 38.6%, p 0.3), neurological (9.2% vs 11.8%, p 0.4), renal (9.8% vs 7.9%, p 0.5), wound (1.4% vs 2.4%, p 0.5), infective (5.5% vs 8.7%, p 0.2), multiple organ failure (4.9% vs 5.5%, p 0.6). The length of intensive care unit (hours) and hospital stay (days) was 71±163.8 vs 106.5±243.7 (p 0.5) and 14.7±14.7 vs 18.9±20.8 (p 0.01). In-hospital mortality resulted in 4.1% for AVR and 3.9% for MVR, p 0.9.
Conclusions: Valve position and valve type do not affect the likelihood of requiring permanent pacing in patients undergoing isolated aortic and mitral valve replacement.
Relevance for patients: A significant proportion of patients undergoing cardiac surgery develop arrhythmias and conduction disturbances post-operatively, often requiring the implantation of a PPM. Determining factors associated with an increase likelihood of permanent pacing would allow the optimisation of per- and intra-operative care, with the aim of reducing the incidence of patients requiring post-operative PPM insertion.
1. Cambridge University Hospitals, Cambridge, UK
2. Hull University Hospitals NHS Trust, Hull, UK
Cambridge University Hospitals, Cambridge, UK
Department of Pharmaceutics, Utrecht University, the Netherlands
Department of Pharmaceutics, Jiaxing University Medical College, Zhejiang, China
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