Leyva Francisco, Qiu Tian, McNulty David, Evison Felicity, Marshall Howard, Gasparini Maurizio
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom.
Quality and Outcomes Research Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Heart Rhythm. 2017 Apr;14(4):529-534. doi: 10.1016/j.hrthm.2016.11.029. Epub 2016 Nov 28.
The risk of permanent pacemaker implantation (PPI) after cardiac valve replacement surgery is thought to be highest in the postoperative period. Long-term risks are uncertain.
The purpose of this study was to determine rates and timing of PPI after cardiac valve replacement surgery.
We compared PPI rates of patients undergoing aortic valve replacement (AVR; n = 111,674), mitral valve replacement (MVR; n = 18,402), AVR + MVR (n = 5166), AVR + MVR + tricuspid valve replacement (TVR; n = 114), or coronary artery bypass surgery (CABG) without valve replacement (n = 249,742).
Over a period of 14 years (median 3.9 years; interquartile range 1.1-7.4 years), cumulative PPI rates were 3.07-7.6 times higher (P < .001 for all) than after CABG, depending on the number of valves replaced. PPI risks after AVR were higher that those after MVR (hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.16-1.28), AVR + MVR (HR 1.52; 95% CI 1.40-1.65), and AVR + MVR + TVR (HR 2.22; 95% CI 1.40-3.53), independent of known confounders. Cumulative PPI hazard rates from the postoperative period to 10 years after surgery increased after AVR (4.22%-14.4%), MVR (4.38%-15.6%), AVR + MVR (5.59%-18.3%), and AVR + MVR + TVR (7.89%-25.9%) (P < .001 for all). Age, male sex, emergency admission, and preexisting diabetes mellitus, renal impairment, and heart failure were independent predictors of PPI (P < .001 for all).
Valve replacement surgery was associated with a long-term risk of PPI. This was particularly high after dual and triple valve replacements. Age, male sex, emergency admission, and preexisting diabetes mellitus, heart failure, and renal impairment were independent predictors of PPI.
心脏瓣膜置换术后永久起搏器植入（PPI）的风险被认为在术后阶段最高。长期风险尚不确定。
本研究的目的是确定心脏瓣膜置换术后PPI的发生率和时间。
我们比较了接受主动脉瓣置换术（AVR；n = 111,674）、二尖瓣置换术（MVR；n = 18,402）、AVR + MVR（n = 5166）、AVR + MVR + 三尖瓣置换术（TVR；n = 114）或无瓣膜置换的冠状动脉旁路移植术（CABG；n = 249,742）患者的PPI发生率。
在14年期间（中位时间3.9年；四分位间距1.1 - 7.4年），根据置换瓣膜的数量，累积PPI发生率比CABG后高3.07 - 7.6倍（所有P <.001）。AVR后的PPI风险高于MVR（风险比[HR] 1.22；95%置信区间[CI] 1.16 - 1.28）、AVR + MVR（HR 1.52；95% CI 1.40 - 1.65）和AVR + MVR + TVR（HR 2.22；95% CI 1.40 - 3.53），与已知混杂因素无关。术后至术后10年的累积PPI风险率在AVR（4.22% - 14.4%）、MVR（4.38% - 15.6%）、AVR + MVR（5.59% - 18.3%）和AVR + MVR + TVR（7.89% - 25.9%）后均增加（所有P <.001）。年龄、男性、急诊入院以及既往糖尿病、肾功能损害和心力衰竭是PPI的独立预测因素（所有P <.001）。
瓣膜置换手术与PPI的长期风险相关。双瓣膜和三瓣膜置换后这种风险尤其高。年龄、男性、急诊入院以及既往糖尿病、心力衰竭和肾功能损害是PPI的独立预测因素。
