Risk of Permanent Pacemaker Implantation Following Bentall Operation
SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY(2024)
Abstract
Conduction disorders following cardiac surgery are common complications with incidences of permanent pacemaker dependency up to 5%. However, data on pacemaker implantation rates in the long-term follow-up after Bentall operations are scarce. In a retrospective study, a mixed cohort of 260 patients including endocarditis and aortic dissection undergoing Bentall operation between March 1996 and December 2015 was analyzed. Median follow-up time was 60 (12-107) months. Early and late rates of permanent pacemaker implantation and associated risk factors were investigated. In the postoperative course 31 (11.9%) permanent pacemakers were implanted. The 30-day incidence of pacemaker implantations was 7.7% with operations performed after a median of 6 (3-12) days after the Bentall operation. After ten years, 21% of the Bentall patients were permanent pacemaker dependent. The risk factors for permanent pacemaker dependency included age above 75 years (16.1% vs. 5.7%; p<0.001), preoperative cardiac conduction disturbance (32.3% vs. 22.7%, p=0.018), aortic valve stenosis (38.7% vs. 23.1, p=0.008), infective endocarditis (19.4% vs. 7.4%, p=0.004), tricuspid valve reconstruction (6.5% vs. 0.9%, p=0.033), sepsis (12.9% vs. 4.4%, p<0.001) and non-cardiac reoperation (19.4% vs. 8.7%, p=0.004). Pacemaker implantation significantly increased the length of initial hospitalization (13 (8-26) days vs. 8 (7-13) days; p=0.003). In the long-term follow-up, mortality was not different between the groups. Permanent pacemaker dependency is a frequent complication in the short- and long-term follow-up after Bentall operations. Screening for cardiac conduction disturbances in the short- and long-term follow-up is recommended.
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Key words
Bentall operation,Conduction disturbances,Pacemaker implantation,Risk factors
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