107 New-onset permanent pacemaker implantation following isolated aortic valve replacement for aortic stenosis in elderly patients

BackgroundNew-onset complete atrioventricular block needing permanent pacemaker implantation (PPI) is a widely recognized complication of cardiac surgery, with an incidence ranging from 3% to 8.5% associated with standard aortic valve replacement (AVR). However, most AVR studies evaluating this complication have included patients with a wide range of ages (including young adults), those undergoing coronary artery bypass grafting during the same intervention, and those with both aortic stenosis and insufficiency as the predominant underlying aortic valve disease. The objectives of this study were 1) to assess the incidence of conduction disturbances leading to PPI following isolated AVR in a large cohort of elderly patients with severe symptomatic aortic stenosis (SSAS), and 2) to determine the predictive factors and prognostic value of PPI following AVR in such patients.MethodsA total of 780 consecutive elderly patients (mean age 77 ± 4 years, logistic EuroSCORE: 10 ± 9%, STS score: 4 ± 2%) with SSAS and no prior pacemaker who had undergone isolated AVR were evaluated. Clinical, echocardiographic, and peri-procedural data were prospectively gathered. The incidence, clinical indications, timing and predictive factors of PPI within 30 days following AVR, as well as their prognostic value were evaluated.ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalization due to the occurrence of complete atrioventricular block (2.6%) or severe symptomatic bradycardia (0.6%). The presence of pre-procedural left bundle branch block (OR: 4.65, 95% CI, 1.62-13.36, P = 0.004) or right bundle branch block (OR: 4.21, 95% CI, 1.47-12.03, P = 0.007) predicted the need for PPI following 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).ConclusionsThe need for PPI following isolated AVR in elderly patients with SSAS was low. Pre-existing bundle branch block predicted the need for PPMI. PPI determined a longer hospital stay, but had no effect on acute and long term mortality. BackgroundNew-onset complete atrioventricular block needing permanent pacemaker implantation (PPI) is a widely recognized complication of cardiac surgery, with an incidence ranging from 3% to 8.5% associated with standard aortic valve replacement (AVR). However, most AVR studies evaluating this complication have included patients with a wide range of ages (including young adults), those undergoing coronary artery bypass grafting during the same intervention, and those with both aortic stenosis and insufficiency as the predominant underlying aortic valve disease. The objectives of this study were 1) to assess the incidence of conduction disturbances leading to PPI following isolated AVR in a large cohort of elderly patients with severe symptomatic aortic stenosis (SSAS), and 2) to determine the predictive factors and prognostic value of PPI following AVR in such patients. New-onset complete atrioventricular block needing permanent pacemaker implantation (PPI) is a widely recognized complication of cardiac surgery, with an incidence ranging from 3% to 8.5% associated with standard aortic valve replacement (AVR). However, most AVR studies evaluating this complication have included patients with a wide range of ages (including young adults), those undergoing coronary artery bypass grafting during the same intervention, and those with both aortic stenosis and insufficiency as the predominant underlying aortic valve disease. The objectives of this study were 1) to assess the incidence of conduction disturbances leading to PPI following isolated AVR in a large cohort of elderly patients with severe symptomatic aortic stenosis (SSAS), and 2) to determine the predictive factors and prognostic value of PPI following AVR in such patients. MethodsA total of 780 consecutive elderly patients (mean age 77 ± 4 years, logistic EuroSCORE: 10 ± 9%, STS score: 4 ± 2%) with SSAS and no prior pacemaker who had undergone isolated AVR were evaluated. Clinical, echocardiographic, and peri-procedural data were prospectively gathered. The incidence, clinical indications, timing and predictive factors of PPI within 30 days following AVR, as well as their prognostic value were evaluated. A total of 780 consecutive elderly patients (mean age 77 ± 4 years, logistic EuroSCORE: 10 ± 9%, STS score: 4 ± 2%) with SSAS and no prior pacemaker who had undergone isolated AVR were evaluated. Clinical, echocardiographic, and peri-procedural data were prospectively gathered. The incidence, clinical indications, timing and predictive factors of PPI within 30 days following AVR, as well as their prognostic value were evaluated. ResultsBaseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalization due to the occurrence of complete atrioventricular block (2.6%) or severe symptomatic bradycardia (0.6%). The presence of pre-procedural left bundle branch block (OR: 4.65, 95% CI, 1.62-13.36, P = 0.004) or right bundle branch block (OR: 4.21, 95% CI, 1.47-12.03, P = 0.007) predicted the need for PPI following 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). Baseline ECG showed the presence of conduction abnormalities in 37.1% of the patients. Twenty-five patients (3.2%) needed PPI during the index hospitalization due to the occurrence of complete atrioventricular block (2.6%) or severe symptomatic bradycardia (0.6%). The presence of pre-procedural left bundle branch block (OR: 4.65, 95% CI, 1.62-13.36, P = 0.004) or right bundle branch block (OR: 4.21, 95% CI, 1.47-12.03, P = 0.007) predicted the need for PPI following 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). ConclusionsThe need for PPI following isolated AVR in elderly patients with SSAS was low. Pre-existing bundle branch block predicted the need for PPMI. PPI determined a longer hospital stay, but had no effect on acute and long term mortality. The need for PPI following isolated AVR in elderly patients with SSAS was low. Pre-existing bundle branch block predicted the need for PPMI. PPI determined a longer hospital stay, but had no effect on acute and long term mortality.