Finke Janina, Pasierski Michał, Dąbrowski Emil J, Kurasz Anna, Brączkowski Jakub, Drzażdżynska Alicja, Benny Aleena, Kozłowski Łukasz, Pawelczak Krzysztof, Stec Sebastian, Kuźma Łukasz, Urbanowicz Tomasz, Lorusso Roberto, Suwalski Piotr, Kowalewski Mariusz
Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
Eur J Cardiothorac Surg. 2025 Jul 1;67(7). doi: 10.1093/ejcts/ezaf210.
This scoping review investigates the prevalence, indications, risk factors, timing and outcomes related to permanent pacemaker implantation following mitral valve surgery.
A comprehensive search of PubMed, Embase and Cochrane databases was conducted to identify studies on permanent pacemaker implantation after mitral valve surgery. Relevant articles discussing prevalence, indications, risk factors, optimal timing, device choice and long-term dependency were included, prioritizing clinical studies and reviews published in the last 2 decades.
The incidence of permanent pacemaker implantation after isolated mitral valve surgeries varies from 1% to 10%, with observation periods ranging from 2 to 12 days across centres. Atrioventricular block is the most common indication. Risk factors include older age, atrial fibrillation, reduced left ventricular function and prior cardiac surgery. Patients undergoing mitral valve replacement face a higher risk compared to those having mitral valve repair, while minimally invasive surgery and left atriotomy approach are linked to a lower permanent pacemaker rate. Long-term pacemaker dependency ranges between 20% and 60%, with increased rates observed in patients with atrioventricular block or those operated in the setting of infective endocarditis.
This review highlights the complex interplay of factors influencing permanent pacemaker implantation after mitral valve surgery. Future research should focus on strategies to reduce postoperative conduction abnormalities and better identify patients who may require permanent pacemaker during long-term follow-up.
本范围综述调查二尖瓣手术后永久性起搏器植入的患病率、适应证、危险因素、时机及结局。
全面检索PubMed、Embase和Cochrane数据库，以识别二尖瓣手术后永久性起搏器植入的研究。纳入讨论患病率、适应证、危险因素、最佳时机、器械选择和长期依赖情况的相关文章，优先选择过去20年发表的临床研究和综述。
单纯二尖瓣手术后永久性起搏器植入的发生率在1%至10%之间，各中心的观察期为2至12天。房室传导阻滞是最常见的适应证。危险因素包括高龄、心房颤动、左心室功能减退和既往心脏手术。与二尖瓣修复术患者相比，二尖瓣置换术患者面临更高的风险，而微创手术和左心房切开术与较低的永久性起搏器植入率相关。长期起搏器依赖率在20%至60%之间，房室传导阻滞患者或在感染性心内膜炎情况下接受手术的患者中观察到该比率增加。
本综述强调了影响二尖瓣手术后永久性起搏器植入的因素之间复杂的相互作用。未来的研究应侧重于减少术后传导异常的策略，并更好地识别在长期随访中可能需要永久性起搏器的患者。
