Elahi Maqsood M, Lee Darren, Dhannapuneni Ramana Rao V
Department of Cardiothoracic Surgery, Punjab Institute of Cardiology, Ghaus-ul-Azam (Jail) Road, Lahore, Pakistan.
Tex Heart Inst J. 2006;33(4):455-7.
The ability to preoperatively identify patients who may require permanent pacemaker implantation is rather poorly understood. The aim of this study is to determine the current incidence of permanent pacing after valve surgery and to determine which factors place the heart valve patient at risk of requiring permanent pacemaker implantation. We audited the records of 2,392 consecutive adult patients who underwent cardiac valve surgical procedures by the same surgical team from 25 April 1998 through 31 March 2003. Of these, 118 patients (group A) required the postoperative implantation of permanent pacemakers during the same hospitalization; they were compared with 1,959 heart valve patients (group B) who did not require pacemaker placement. Multivariate logistic regression analysis showed that reoperations (odds ratio [OR], 8.23; P <0.001), longer cumulative cross-clamp times (OR, 5.9; P <0.001), multiple-valve surgical procedures (OR, 3.46; P <0.05), and absence of preoperative sinus rhythm (OR 2.52; P <0.001) were independent predictors of the need for permanent pacemaker implantation after valve surgery. These results suggest that patients who display these risk factors for arrhythmias that require permanent pacemaker implantation receive closer observation and advance counseling about the likelihood of such implantation.
术前识别可能需要植入永久性起搏器的患者的能力目前还了解甚少。本研究的目的是确定瓣膜手术后永久性起搏的当前发生率，并确定哪些因素使心脏瓣膜病患者有植入永久性起搏器的风险。我们审计了1998年4月25日至2003年3月31日期间由同一手术团队连续进行心脏瓣膜手术的2392例成年患者的记录。其中，118例患者（A组）在同一住院期间需要术后植入永久性起搏器；将他们与1959例不需要起搏器植入的心脏瓣膜病患者（B组）进行比较。多因素逻辑回归分析显示，再次手术（比值比[OR]，8.23；P<0.001）、累计交叉夹闭时间延长（OR，5.9；P<0.001）、多瓣膜手术（OR，3.46；P<0.05）以及术前无窦性心律（OR 2.52；P<0.001）是瓣膜手术后需要植入永久性起搏器的独立预测因素。这些结果表明，对于那些显示出这些需要植入永久性起搏器的心律失常危险因素的患者，应进行更密切的观察，并就植入这种起搏器的可能性给予提前咨询。
