Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Eur J Cardiothorac Surg. 2021 Jul 14;60(1):140-147. doi: 10.1093/ejcts/ezab091.
Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited.
Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan-Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival.
A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12-1.35), concomitant aortic (1.44; 1.10-1.90) and tricuspid valve procedures (2.21; 1.64-2.97) and prior history of myocardial infarction (1.48; 1.07-1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19-8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality.
Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.
心脏瓣膜手术后需要植入永久性起搏器（PPM）仍然是一种并发症。PPM 会增加感染、三尖瓣反流和起搏诱导性心肌病的风险。目前，关于二尖瓣手术（MVS）中 PPM 放置的文献有限。
我们回顾性地分析了 2011 年至 2019 年期间接受手术的成年患者的机构二尖瓣（MV）数据库。排除术前有 PPM 的患者。根据患者指数手术后是否植入 PPM 将患者分层。采用多变量逻辑回归确定 PPM 的患者和手术风险因素。对接受单纯 MVS 的患者进行亚组分析。采用 Kaplan-Meier 分析和多变量 Cox 比例风险模型评估 PPM 植入与长期生存之间的关系。
共有 3391 名（2991 名非 PPM 和 400 名 PPM）患者符合研究标准。PPM 的显著预测因素包括年龄增加（优势比：1.23；95%置信区间：1.12-1.35）、同期主动脉瓣（1.44；1.10-1.90）和三尖瓣手术（2.21；1.64-2.97）以及既往心肌梗死史（1.48；1.07-1.86）。在单纯 MV 修复人群中，环瓣成形术与 PPM 相关（3.09；1.19-8.02）。置换组患者没有明显的可识别风险因素。没有发现生存差异，术后 PPM 植入也不是死亡率的独立预测因素。
我们的主要目的是阐明 MVS 中 PPM 植入的预测因素，发现年龄增加和同期手术是危险因素。植入 PPM 与较差的长期生存相关，但不能独立预测生存。在接受单纯 MV 修复的患者中，与使用环瓣成形术环相比，使用瓣环成形术环会增加 PPM 的风险。
