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Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival.
Ann Thorac Surg. 2018 08; 106(2):460-465.AT

Abstract

BACKGROUND

Permanent pacemaker (PPM) implantation has been touted as an inconsequential complication after transcatheter aortic valve replacement. As transcatheter aortic valve replacement moves to lower risk patients, the long-term implications remain poorly understood; therefore, we evaluated the long-term outcomes of pacemaker for surgical aortic valve replacement patients.

METHODS

A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modeling.

RESULTS

A total of 72 patients (2.7%) required PPM placement postoperatively. Patients requiring PPM had more postoperative complications, including atrial fibrillation (43.1% versus 27.0%, p = 0.003), prolonged ventilation (16.7% versus 5.7%, p < 0.0001), and renal failure (12.5% versus 4.6%, p = 0.002). These led to greater resource utilization including longer intensive care unit stay (89 versus 44 hours, p < 0.0001) and hospital length of stay (9 versus 6 days, p < 0.0001), and higher inflation-adjusted hospital cost ($81,000 versus $47,000, p < 0.0001). Median follow-up was 7.5 years, and patients requiring PPM had significantly worse long-term survival (p = 0.02), even after risk adjustment with STS predicted risk of mortality (hazard ratio 1.48, p = 0.02).

CONCLUSIONS

The need for PPM after aortic valve replacement independently reduces long-term survival. The rate of PPM placement after surgical aortic valve replacement remains very low but dramatically increases resource utilization. As transcatheter aortic valve replacement expands to low-risk patients, the impact of PPM placement on long-term survival warrants close monitoring.

Authors+Show Affiliations

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Electronic address: gorav@virginia.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29577930

Citation

Mehaffey, J Hunter, et al. "Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival." The Annals of Thoracic Surgery, vol. 106, no. 2, 2018, pp. 460-465.
Mehaffey JH, Haywood NS, Hawkins RB, et al. Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival. Ann Thorac Surg. 2018;106(2):460-465.
Mehaffey, J. H., Haywood, N. S., Hawkins, R. B., Kern, J. A., Teman, N. R., Kron, I. L., Yarboro, L. T., & Ailawadi, G. (2018). Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival. The Annals of Thoracic Surgery, 106(2), 460-465. https://doi.org/10.1016/j.athoracsur.2018.02.041
Mehaffey JH, et al. Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival. Ann Thorac Surg. 2018;106(2):460-465. PubMed PMID: 29577930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival. AU - Mehaffey,J Hunter, AU - Haywood,Nathan S, AU - Hawkins,Robert B, AU - Kern,John A, AU - Teman,Nicholas R, AU - Kron,Irving L, AU - Yarboro,Leora T, AU - Ailawadi,Gorav, Y1 - 2018/03/22/ PY - 2017/11/25/received PY - 2018/01/30/revised PY - 2018/02/11/accepted PY - 2018/3/27/pubmed PY - 2019/8/17/medline PY - 2018/3/27/entrez SP - 460 EP - 465 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 106 IS - 2 N2 - BACKGROUND: Permanent pacemaker (PPM) implantation has been touted as an inconsequential complication after transcatheter aortic valve replacement. As transcatheter aortic valve replacement moves to lower risk patients, the long-term implications remain poorly understood; therefore, we evaluated the long-term outcomes of pacemaker for surgical aortic valve replacement patients. METHODS: A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modeling. RESULTS: A total of 72 patients (2.7%) required PPM placement postoperatively. Patients requiring PPM had more postoperative complications, including atrial fibrillation (43.1% versus 27.0%, p = 0.003), prolonged ventilation (16.7% versus 5.7%, p < 0.0001), and renal failure (12.5% versus 4.6%, p = 0.002). These led to greater resource utilization including longer intensive care unit stay (89 versus 44 hours, p < 0.0001) and hospital length of stay (9 versus 6 days, p < 0.0001), and higher inflation-adjusted hospital cost ($81,000 versus $47,000, p < 0.0001). Median follow-up was 7.5 years, and patients requiring PPM had significantly worse long-term survival (p = 0.02), even after risk adjustment with STS predicted risk of mortality (hazard ratio 1.48, p = 0.02). CONCLUSIONS: The need for PPM after aortic valve replacement independently reduces long-term survival. The rate of PPM placement after surgical aortic valve replacement remains very low but dramatically increases resource utilization. As transcatheter aortic valve replacement expands to low-risk patients, the impact of PPM placement on long-term survival warrants close monitoring. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/29577930/Need_for_Permanent_Pacemaker_After_Surgical_Aortic_Valve_Replacement_Reduces_Long_Term_Survival_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(18)30372-2 DB - PRIME DP - Unbound Medicine ER -