Risk of Permanent Pacemaker Implantation Following Bentall Operation

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.