Lewis J W, Webb C R, Pickard S D, Lehman J, Jacobsen G
Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, Detroit, Mich 48202, USA.
J Thorac Cardiovasc Surg. 1998 Jul;116(1):74-81. doi: 10.1016/S0022-5223(98)70245-4.
The requirement for permanent pacemaker implantation after most initial cardiac surgical procedures generally is less than 3%. To identify the incidence and factors related to permanent pacemaker need after repeat cardiac surgery, we retrospectively studied 558 consecutive patients undergoing at least one repeat cardiac operation.
Univariable and multivariable analyses of comorbidity, preoperative catheterization values, and operative data were performed to identify factors related to pacemaker implantation.
In this group, 54 patients (9.7%) required a permanent pacemaker. A multivariable model showed a relationship between a permanent pacemaker and tricuspid valve replacement/annuloplasty associated with aortic/mitral valve replacement, preoperative endocarditis, increasing number of reoperations, the degree of hypothermia during cardiopulmonary bypass, and advanced age. Additional univariable predictors of pacemaker need included multiple valve replacement, increased cardiopulmonary bypass and aortic crossclamp times, and aortic valve replacement. Over 90% of patients who have or have not received permanent pacemaker implantation were in New York Heart Association class I to II, with a mean follow-up time of 6 years. Kaplan-Meier survival curves were statistically similar for both groups at 5 and 10 years after the operation.
Permanent pacemaker implantation was required in 9.7% of patients undergoing repeat cardiac surgery. This represented approximately a fourfold increase compared with similar primary operations reported in other series. Factors strongly related to this need included valve replacement, preoperative endocarditis, number of reoperations, advanced age, and degree of hypothermia during cardiopulmonary bypass. The need for a permanent pacemaker after reoperations did not result in significant long-term impairment of functional status or longevity compared with those who did not require a permanent pacemaker.
大多数初次心脏外科手术后永久性起搏器植入的需求通常低于3%。为了确定再次心脏手术后永久性起搏器需求的发生率及相关因素，我们回顾性研究了558例至少接受过一次再次心脏手术的连续患者。
对合并症、术前导管检查值和手术数据进行单变量和多变量分析，以确定与起搏器植入相关的因素。
在该组中，54例患者（9.7%）需要植入永久性起搏器。多变量模型显示，永久性起搏器与三尖瓣置换/瓣环成形术合并主动脉/二尖瓣置换、术前心内膜炎、再次手术次数增加、体外循环期间的低温程度以及高龄之间存在关联。起搏器需求的其他单变量预测因素包括多瓣膜置换、体外循环和主动脉阻断时间增加以及主动脉瓣置换。超过90%接受或未接受永久性起搏器植入的患者心功能分级为纽约心脏协会I至II级，平均随访时间为6年。两组患者术后5年和10年的Kaplan-Meier生存曲线在统计学上相似。
9.7%的再次心脏手术患者需要植入永久性起搏器。这比其他系列报道的类似初次手术增加了约四倍。与这种需求密切相关的因素包括瓣膜置换、术前心内膜炎、再次手术次数、高龄以及体外循环期间的低温程度。与不需要永久性起搏器的患者相比，再次手术后对永久性起搏器的需求并未导致功能状态或寿命的显著长期损害。
