Lee Jun Ho, Kim Yun Jin, Kim Ji Eon, Song Kyungsub, Shin Yonghoon, Jung Jae Seung, Son Ho Sung, Lee Seung Hyun, Kim Hee Jung
Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Eur J Cardiothorac Surg. 2025 Feb 4;67(2). doi: 10.1093/ejcts/ezaf018.
This study aimed to evaluate the prognostic impact of permanent pacemaker (PPM) implantation within the first year after mitral valve (MV) surgery combined with the Cox-maze procedure, focusing on long-term outcomes, including overall mortality, infective endocarditis (IE) and ischaemic stroke.
We conducted a retrospective cohort study using data from the National Health Insurance Service (NHIS) in South Korea, identifying 10 127 patients who underwent MV surgery with the Cox-maze procedure between 2005 and 2020. Patients were classified into the PPM and non-PPM groups based on PPM implantation within 1 year postoperatively. The primary outcome was overall mortality, and secondary outcomes included risk factors for overall mortality, IE and ischaemic stroke. Multivariable Cox proportional hazards regression and Fine-Gray competing risk models were utilized for statistical analysis.
Of the total cohort, 178 patients (1.76%) underwent PPM implantation. The overall mortality during the follow-up period was 20.5%, with no significant difference between the PPM and non-PPM groups. PPM implantation was not a significant risk factor for overall mortality (hazard ratio [HR], 0.825; 95% confidence interval [CI] 0.598-1.140; P = 0.244) or ischaemic stroke. However, PPM implantation was associated with a significantly increased risk of IE (HR, 2.015; 95% CI 1.179-3.442; P = 0.010).
PPM implantation within the first year after MV surgery with the Cox-maze procedure does not significantly impact long-term mortality or ischaemic stroke risk but is associated with an increased risk of IE. The Cox-maze procedure remains advisable for patients with atrial fibrillation undergoing MV surgery.
本研究旨在评估二尖瓣（MV）手术联合Cox迷宫手术术后第一年内植入永久性起搏器（PPM）对预后的影响，重点关注长期结局，包括全因死亡率、感染性心内膜炎（IE）和缺血性卒中。
我们进行了一项回顾性队列研究，使用韩国国民健康保险服务（NHIS）的数据，确定了2005年至2020年间接受MV手术联合Cox迷宫手术的10127例患者。根据术后1年内是否植入PPM将患者分为PPM组和非PPM组。主要结局是全因死亡率，次要结局包括全因死亡率、IE和缺血性卒中的危险因素。采用多变量Cox比例风险回归和Fine-Gray竞争风险模型进行统计分析。
在整个队列中，178例患者（1.76%）接受了PPM植入。随访期间的全因死亡率为20.5%，PPM组和非PPM组之间无显著差异。PPM植入不是全因死亡率（风险比[HR]，0.825；95%置信区间[CI]0.598-1.140；P=0.244）或缺血性卒中的显著危险因素。然而，PPM植入与IE风险显著增加相关（HR，2.015；95%CI 1.179-3.442；P=0.010）。
MV手术联合Cox迷宫手术后第一年内植入PPM对长期死亡率或缺血性卒中风险无显著影响，但与IE风险增加相关。对于接受MV手术的房颤患者，Cox迷宫手术仍然是可取的。
