Department of Medicine, Chang Gung University.
Chang Gung Memorial Hospital, Linkou Medical Center Shin Kong Wu Ho-Su Memorial Hospital.
Circ J. 2021 Jun 25;85(7):1027-1034. doi: 10.1253/circj.CJ-20-0905. Epub 2021 Mar 19.
Patients are prone to permanent pacemaker implantation (PPM) after valve surgery, yet current data on the effects of postoperative PPM are scarce and large-scale studies are lacking. The aim of this study was to determine rates and long-term outcomes of PPM after cardiac valve surgery.
A total of 24,014 patients who received valve surgery from 2000 to 2013 were identified from the Taiwan National Health Insurance Research Database. The number of valve surgeries and the proportion of PPM implantations after valve surgery increased (P<0.001). After 1 : 5 propensity score matching, 602 and 3,010 patients were categorized to the PPM and non-PPM groups, respectively. Late outcomes included all-cause mortality, cardiovascular death, sepsis, and readmission due to any cause. The mean follow up was 4.3 years. PPM was associated with a higher all-cause mortality rate (33.6% vs. 29.8%; hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.98-1.32), though not significant at the threshold of P<0.05. PPM was also associated with higher all-cause mortality rates in subgroups that received mitral valve (MV) replacement surgery, combined aortic valve replacement (AVR) with MV surgeries, and combined AVR with tricuspid valve surgeries.
The PPM rate after valve surgery is increasing, and is associated with short-term adverse effects. Patients with PPM may have a higher long-term mortality rate.
瓣膜手术后患者容易发生永久性起搏器植入（PPM），但目前关于术后 PPM 影响的资料有限，且缺乏大规模研究。本研究旨在确定心脏瓣膜手术后 PPM 的发生率和长期结局。
从台湾全民健康保险研究数据库中确定了 2000 年至 2013 年接受瓣膜手术的 24014 例患者。瓣膜手术数量和瓣膜手术后 PPM 植入的比例均增加（P<0.001）。经过 1:5 倾向评分匹配后，将 602 例和 3010 例患者分别分为 PPM 组和非 PPM 组。晚期结局包括全因死亡率、心血管死亡率、脓毒症和因任何原因再次入院。平均随访时间为 4.3 年。PPM 与全因死亡率较高相关（33.6% vs. 29.8%；风险比 [HR]，1.14；95%置信区间 [CI]，0.98-1.32），尽管在 P<0.05 的阈值下无统计学意义。PPM 与接受二尖瓣（MV）置换手术、主动脉瓣置换（AVR）联合 MV 手术和 AVR 联合三尖瓣手术的亚组的全因死亡率较高相关。
瓣膜手术后 PPM 的发生率正在增加，且与短期不良影响相关。接受 PPM 的患者可能具有更高的长期死亡率。
