Assessing the risk factors of permanent pacemaker implantation following mitral valve surgery: A systematic review and meta-analysis.

BACKGROUND

Mitral valve surgery is a widely performed intervention for the treatment of various mitral valve pathologies. Postoperative conduction disturbances may necessitate permanent pacemaker (PPM) implantation. This study aims to identify and quantify patient-related, cardiovascular, procedural risk factors, and risk score-based predictors of PPM implantation following mitral valve surgery.

METHODS

The conduct of this systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. A systematic literature search was performed across PubMed, Cochrane Library, Google Scholar, and Embase, including studies published from inception until September 2024. Statistical analyses were conducted using RevMan 5.4 software.

RESULTS

The meta-analysis included 8 studies totaling 39,634 patients (PPM: 3417; no PPM: 36,217) and revealed multiple significant predictors of postoperative PPM implantation. Among demographics, advanced age (mean difference [MD] 3.54; P < .00001) and female sex (odds ratio [OR] 1.19; P < .00001) were found as independent risk factors. Comorbidities included hypertension (OR 1.71, P < .00001), diabetes (OR 1.96, P < .00001), renal disease (OR 1.96, P < .00001), preexisting atrial fibrillation (OR 1.82, P < .00001), prior stroke (OR 1.57, P < .00001), chronic lung disease (OR 1.38, P < .00001), peripheral vascular disease (OR 2.03, P = .01), and smoking history (OR 1.19, P < .0001). Cardiovascular predictors comprised mitral stenosis (OR 1.77, P <.00001), prior cardiac surgery (OR 1.48, P = .0002), New York Heart Association class III/IV (OR 1.38, P = .005), and New York Heart Association class I (OR 0.64, P = .03). Procedural factors showed longer cardiopulmonary bypass time (MD 9.89, P < .00001) and aortic cross-clamp duration (MD 11.96, P < .00001) increasing risk, along with concomitant atrial fibrillation ablation (OR 1.34, P = .002). Increased society of thoracic surgeons' mortality risk (MD 1.14%, P = .04) and EuroScore (MD 2.16, P = .0005), both effectively predicted PPM need.

CONCLUSION

This meta-analysis represents the first comprehensive evaluation of risk factors associated with PPM implantation in patients undergoing mitral valve surgery. Several significant risk factors have been identified, warranting further research to validate and expand upon these findings.