Incidence, risk factors, and long-term outcomes associated with permanent pacemaker implantation after aortic root replacement

• Published in: The Journal of thoracic and cardiovascular surgery
• Main Authors: Singh, Sameer K., Levine, Dov, Norton, Elizabeth L., Patel, Parth, Kurlansky, Paul, Rajesh, Kavya, Chung, Megan, Olakunle, Oreoluwa, Leshnower, Bradley, Chen, Edward P., Takayama, Hiroo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 20-07-2024
• Subjects: aortic root replacement; bicuspid aortic valve; permanent pacemaker; valve sparing aortic root replacement; ARR; bicuspid aortic valve; valve sparing aortic root replacement; CVG; VSRR; BAV; PPI; aortic root replacement; AVR; permanent pacemaker
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2024.07.024

Permanent pacemaker implantation (PPI) after aortic valve replacement is associated with long-term mortality. However, data regarding PPI after aortic root replacement (ARR) is lacking. Herein we describe the incidence, risk factors, and long-term outcomes of PPI after ARR.
Consecutive patients undergoing ARR from 2005 to 2020 were selected after excluding those with endocarditis, type A dissection, or preoperative PPI. Patients requiring PPI after ARR were identified, along with the indication and timing. Independent factors associated with PPI after ARR were identified and long-term survival was assessed.
The incidence of PPI was 3.8% (n = 85) among 2240 patients undergoing ARR. PPI was performed a median of 7 days (interquartile range, 5-12 days) after ARR most commonly for complete heart block (73%). Bicuspid aortic valve (odds ratio [OR], 1.89; P = .02), female sex (OR, 1.74; P = .04), preoperative heart block (OR, 2.70; P = .02), and prior aortic valve replacement (OR, 2.18; P = .01) were independently associated with PPI while preoperative aortic insufficiency (OR, 0.52; P = .01) and valve-sparing root replacement procedure compared with bio-Bentall (OR, 0.40; P = .01) were protective. Patients requiring PPI after ARR were not at increased risk of operative or long-term mortality compared with patients not requiring PPI (P = .26); however, those undergoing PPI experienced significantly longer hospital length of stay (13 vs 7 days; P < .001).
The incidence of PPI after ARR remains low, particularly after VSRR. Preoperative conduction disturbance, prior AVR, and bicuspid aortic valve are all associated with increased risk of PPI. Although PPI is associated with longer length of stay, it is not associated with early or late mortality.
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