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Permanent pacemaker implantation following isolated aortic valve replacement in a large cohort of elderly patients with severe aortic stenosis
  1. Rodrigo Bagur1,
  2. Juan Maria Manazzoni1,
  3. Éric Dumont2,
  4. Daniel Doyle2,
  5. Jean Perron2,
  6. François Dagenais2,
  7. Patrick Mathieu2,
  8. Richard Baillot2,
  9. Éric Charbonneau2,
  10. Jacques Metrás2,
  11. Siamak Mohammadi2,
  12. Mélanie Côté1,
  13. François Philippon1,
  14. Pierre Voisine2,
  15. Josep Rodés-Cabau1
  1. 1Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
  2. 2Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
  1. Correspondence to Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec G1V 4G5, Canada; josep.rodes{at}criucpq.ulaval.ca

Abstract

Objectives To assess the incidence of conduction disturbances leading to permanent pacemaker implantation (PPI) following isolated aortic valve replacement (AVR) in a large cohort of elderly patients with severe symptomatic aortic stenosis, and to determine the predictive factors and prognostic value of PPI following AVR in such patients.

Methods A total of 780 consecutive elderly patients (age 77±4 years, logistic EuroSCORE 10.4±8.5%, STS score 3.5±1.5%) with severe aortic stenosis and no previous pacemaker were analysed.

Main outcome measures The incidence, clinical indications, timing and predictive factors of PPI within 30 days after AVR and their prognostic value were evaluated.

Results Baseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalisation due to the occurrence of complete atrioventricular block (2.6%) or severe bradycardia (0.6%). The presence of preprocedural left bundle branch block (OR 4.65, 95% CI 1.62 to 13.36, p=0.004) or right bundle branch block (OR 4.21, 95% CI 1.47 to 12.03, p=0.007) predicted the need for PPI after AVR. The need for PPI was associated with a longer hospital stay (p<0.0001). Thirty-day mortality rates were similar between patients with and without PPI (4% vs 3.2%, p=0.56). Survival rate at 5-year follow-up was 75%, with no differences between patients with and without PPI (p=0.12).

Conclusions The need for PPI following isolated AVR in elderly patients with severe symptomatic aortic stenosis was low. Pre-existing bundle branch block predicted the need for PPI. PPI determined a longer hospital stay, but had no effect on acute and long-term mortality.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study protocol was performed in accordance with the institutional ethics committee and patients provided a signed informed consent for the procedures and the anonymous use of their data for research purposes.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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