Kogan Alexander, Sternik Leonid, Beinart Roy, Shalabi Amjad, Glikson Michael, Spiegelstein Danny, Levin Shany, Raanani Ehud
Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pacing Clin Electrophysiol. 2015 Apr;38(4):424-30. doi: 10.1111/pace.12569. Epub 2015 Jan 13.
Permanent pacemaker (PPM) implantation is required in 3-12% of all patients undergoing surgical aortic valve replacement (AVR). Our aim was to evaluate the contemporary incidence and impact of the introduction of transcatheter aortic valve implantation (TAVI) for PPM insertion after isolated AVR.
Since 2004, during a 10-year period, a total of 858 patients underwent isolated AVR at our institution. Forty-one patients with PPM before operation were excluded from the study and 817 patients were included in the statistical analysis. Of these, 20 patients (2.45%) developed significant conduction disorders, leading to PPM implantation within 120 days postoperatively. Patients were further divided into two groups. Before (Group I: June 2004 to September 2008) and after (Group II: October 2008 to May 2014) the introduction of the TAVI program.
There were 343 patients in Group I and 475 patients in Group II. The incidence of PPM implantation decreased from 3.79% (13 patients) in Group I to 1.47% (seven patients) in Group II (P < 0.001). Risk factors for permanent pacing identified by univariate analysis were: Group I (before introducing TAVI program), pulmonary hypertension, preoperative anemia, age older than 75 years, and previous myocardial infarction. Multivariate analysis identified Group I (before introducing TAVI program; P < 0.005; odds ratio [OR] 15.2, 95% confidence interval [CI] 6.3-19.9) and pulmonary hypertension (P < 0.005; OR 12.5, 95% CI 3.2-18.3) to be significant.
Irreversible atrio-ventricular block or symptomatic bradycardia requiring PPM implantation is a relatively rare complication. The incidence of PPM implantation after isolated surgical AVR decreased in a contemporary setting after the introduction of the TAVI program.
在所有接受外科主动脉瓣置换术（AVR）的患者中，有3% - 12%需要植入永久性起搏器（PPM）。我们的目的是评估在单纯AVR术后引入经导管主动脉瓣植入术（TAVI）用于PPM植入的当代发生率及影响。
自2004年起，在10年期间，我院共有858例患者接受了单纯AVR手术。41例术前已植入PPM的患者被排除在研究之外，817例患者纳入统计分析。其中，20例（2.45%）出现严重传导障碍，导致术后120天内植入PPM。患者进一步分为两组。在引入TAVI计划之前（第一组：2004年6月至2008年9月）和之后（第二组：2008年10月至2014年5月）。
第一组有343例患者，第二组有475例患者。PPM植入率从第一组的3.79%（13例）降至第二组的1.47%（7例）（P < 0.001）。单因素分析确定的永久性起搏危险因素为：第一组（引入TAVI计划之前）、肺动脉高压、术前贫血、年龄大于75岁和既往心肌梗死。多因素分析确定第一组（引入TAVI计划之前；P < 0.005；比值比[OR] 15.2，95%置信区间[CI] 6.3 - 19.9）和肺动脉高压（P < 0.005；OR 12.5，95% CI 3.2 - 18.3）具有显著性。
需要植入PPM的不可逆房室传导阻滞或症状性心动过缓是一种相对罕见的并发症。在引入TAVI计划后的当代环境中，单纯外科AVR术后PPM植入率有所下降。
