Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses : the CAREAVR study

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Salmi , S J , Nieminen , T , Hartikainen , J , Biancari , F , Lehto , J , Nissinen , M , Malmberg , M , Yannopoulos , F , Savolainen , J , Airaksinen , J & Kiviniemi , T 2020 , ' Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses : the CAREAVR study ' , Interactive cardiovascular and thoracic surgery. , vol. 31 , no. 3 , pp. 398-404 . https://doi.org/10.1093/icvts/ivaa119

Title: Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses : the CAREAVR study
Author: Salmi, Samuli J.; Nieminen, Tuomo; Hartikainen, Juha; Biancari, Fausto; Lehto, Joonas; Nissinen, Maunu; Malmberg, Markus; Yannopoulos, Fredrik; Savolainen, Jyri; Airaksinen, Juhani; Kiviniemi, Tuomas
Contributor organization: HUS Internal Medicine and Rehabilitation
Clinicum
Department of Medicine
University of Helsinki
Helsinki University Hospital Area
South Carelia Social and Health care District Eksote
HYKS erva
Päijät-Häme Welfare Consortium
HUS Heart and Lung Center
Date: 2020-09
Language: eng
Number of pages: 7
Belongs to series: Interactive cardiovascular and thoracic surgery.
ISSN: 1569-9293
DOI: https://doi.org/10.1093/icvts/ivaa119
URI: http://hdl.handle.net/10138/332812
Abstract: OBJECTIVES: We sought to study the indications, long-term occurrence, and predictors of permanent pacemaker implantation (PPI) after isolated surgical aortic valve replacement with bioprostheses. METHODS: The CAREAVR study included 704 patients (385 females, 54.7%) without a preoperative PPI (mean +/- standard deviation age 75 +/- 7years) undergoing isolated surgical aortic valve replacement at 4 Finnish hospitals between 2002 and 2014. Data were extracted from electronic patient records. RESULTS: The follow-up was median 4.7years (range 1day to 12.3years). Altogether 56 patients received PPI postoperatively, with the median 507days from the operation (range 6days to 10.0years). The PPI indications were atrioventricular block (31 patients, 55%) and sick sinus syndrome (21 patients, 37.5%). For 4 patients, the PPI indication remained unknown. A competing risks regression analysis (Fine-Gray method), adjusted with age, sex, diabetes, coronary artery disease, preoperative atrial fibrillation (AF), left ventricular ejection fraction, New York Heart Association class, AF at discharge and urgency of operation, was used to assess risk factors for PPI. Only AF at discharge (subdistribution hazard ratio 4.34, 95% confidence interval 2.34-8.03) was a predictor for a PPI. CONCLUSIONS: Though atrioventricular block is the major indication for PPI after surgical aortic valve replacement, >30% of PPIs are implanted due to sick sinus syndrome during both short-term follow-up and long-term follow-up. Postoperative AF versus sinus rhythm conveys >4-fold risk of PPI.
Subject: Aortic valve replacement
Conduction impairment
Permanent pacemaker implantation
Risk factor
PERMANENT PACEMAKER
RISK-FACTORS
LONG-TERM
CONDUCTION DISORDERS
SEPTAL-DEFECT
ARRHYTHMIAS
SURGERY
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion


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