Alwaqfi Nizar R, Ibrahim Khaled S, Khader Yousef S, Baker Ahmad Abu
Department of General Surgery, Jordan University of Science and Technology and King Abdullah University Hospital, Princess Muna Heart Center, Floor 8 C, Po Box 630001, Irbid 22110, Jordan.
J Cardiothorac Surg. 2014 Feb 12;9:33. doi: 10.1186/1749-8090-9-33.
Although temporary cardiac pacing is infrequently needed, temporary epicardial pacing wires are routinely inserted after valve surgery. As they are associated with infrequent, but life threatening complications, and the decreased need for postoperative pacing in a group of low risk patients; this study aims to identify the predictors of temporary cardiac pacing after valve surgery.
A retrospective analysis of data collected prospectively on 400 consecutive valve surgery patients between May 2002 and December 2012 was performed. Patients were grouped according to avoidance or insertion of temporary pacing wires, and were further subdivided according to temporary cardiac pacing need. Multiple logistic regression was used to determine the predictors of temporary cardiac pacing.
170 (42.5%) patients did not have insertion of temporary pacing wires and none of them needed temporary pacing. 230 (57.5%) patients had insertion of temporary pacing wires and among these, only 55 (23.9%) required temporary pacing who were compared with the remaining 175 (76.1%) patients in the main analysis. The determinants of temporary cardiac pacing (adjusted odds ratios; 95% confidence interval) were as follows: increased age (1.1; 1.1, 1.3, p=0.002), New York Heart Association class III- IV (5.6; 1.6, 20.2, p=0.008) , pulmonary artery pressure ≥ 50 mmHg (22.0; 3.4, 142.7, p=0.01), digoxin use (8.0; 1.3, 48.8, p=0.024), multiple valve surgery (13.5; 1.5, 124.0, p=0.021), aorta cross clamp time ≥ 60 minutes (7.8; 1.6, 37.2, p=0.010), and valve annulus calcification (7.9; 2.0, 31.7, p=0.003).
Although limited by sample size, the present results suggest that routine use of temporary epicardial pacing wires after valve surgery is only necessary for high risk patients. Preoperative identification and aggressive management of predictors of temporary cardiac pacing and the possible modulation of intraoperative techniques can decrease the need of temporary cardiac pacing. Prospective randomized controlled studies on a larger number of patients are necessary to draw solid conclusions regarding the selective use of temporary epicardial pacing wires in valve surgery.
尽管临时心脏起搏很少需要，但在瓣膜手术后通常会常规插入临时心外膜起搏导线。由于它们与罕见但危及生命的并发症相关，并且一组低风险患者术后起搏需求减少；本研究旨在确定瓣膜手术后临时心脏起搏的预测因素。
对2002年5月至2012年12月期间连续400例瓣膜手术患者前瞻性收集的数据进行回顾性分析。患者根据是否避免或插入临时起搏导线进行分组，并根据临时心脏起搏需求进一步细分。采用多因素logistic回归确定临时心脏起搏的预测因素。
170例（42.5%）患者未插入临时起搏导线，且无一例需要临时起搏。230例（57.5%）患者插入了临时起搏导线，其中只有55例（23.9%）需要临时起搏，这些患者在主要分析中与其余175例（76.1%）患者进行了比较。临时心脏起搏的决定因素（调整后的比值比；95%置信区间）如下：年龄增加（1.1；1.1，1.3，p = 0.002）、纽约心脏协会III-IV级（5.6；1.6，20.2，p = 0.008）、肺动脉压≥50 mmHg（22.0；3.4，142.7，p = 0.01）、使用地高辛（8.0；1.3，48.8，p = 0.024）、多瓣膜手术（13.5；1.5，124.0，p = 0.021）、主动脉阻断时间≥60分钟（7.8；1.6，37.2，p = 0.010）和瓣膜环钙化（7.9；2.0，31.7，p = 0.003）。
尽管受样本量限制，目前的结果表明瓣膜手术后常规使用临时心外膜起搏导线仅对高危患者必要。术前识别和积极处理临时心脏起搏的预测因素以及术中技术的可能调整可以减少临时心脏起搏的需求。需要对更多患者进行前瞻性随机对照研究，以得出关于瓣膜手术中选择性使用临时心外膜起搏导线的确切结论。
