Impact of Pacemaker Implantation on Long-Term Survival After Mitral Valve Surgery.

Abstract

Conduction disorders requiring permanent pacemaker implantation (PPM) after aortic valve surgery have been associated with reduced long-term survival. However, data regarding PPM after mitral valve surgery (MVS) have been limited. We evaluated the impact of new PPM on long-term survival after MVS. All patients who underwent MVS from 2000-2022 at a single institution were stratified by need for a new postoperative PPM. The primary outcome was long-term survival. To evaluate resource use, secondary outcomes included intensive care unit (ICU) length of stay and 30-day hospital readmission. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the association between PPM and long-term survival. Among 4690 patients who underwent MVS, 245 (5.2%) required PPM. Patients requiring PPM had more preoperative risk factors, including previous cardiac intervention (47.4% vs 35.3%, P < .01) and concomitant cardiac procedures (89.8% vs 71.42%, P < .01). Patients with PPM had longer ICU lengths of stay (128 hours [interquartile range, 69-194 hours] vs 52 hours [interquartile range, 28-96 hours], P < .01) and more ICU readmissions (19.6% vs 10.8%, P < .01). Kaplan-Meier analysis showed PPM was associated with decreased 10-year survival (P < .01). After adjusting for preoperative risk factors and concomitant operations, PPM was not independently associated with worse long-term survival (hazard ratio, 0.70; 95% CI, 0.40-1.3; P = .28). PPM after MVS is not independently associated with worse long-term survival. However, patients requiring PPM have worse clinical status at baseline. These findings demonstrate the importance of identifying patients at risk for PPM to facilitate perioperative planning to improve resource use and survival.