HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph W. Lewis, Jr. Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lewis, J. W. Articles by Jacobsen, G. Search for Related Content PubMed PubMed Citation Articles by Lewis, J. W., Jr. Articles by Jacobsen, G.

J Thorac Cardiovasc Surg 1998;116:74-78
© 1998 Mosby, Inc.

Surgery For Adult Cardiovascular Disease

The increased need for a permanent pacemaker after reoperative cardiac surgery

From the Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, Detroit, Mich.

Received for publication Dec. 24, 1996. Revisions requested Feb. 20, 1997; revisions received Feb. 13, 1998. Accepted for publication Feb. 13, 1998. Address for reprints: Joseph W. Lewis, Jr., MD, Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202.

Objective: 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.
Method: Univariable and multivariable analyses of comorbidity, preoperative catheterization values, and operative data were performed to identify factors related to pacemaker implantation.
Results: 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.
Conclusion: 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.

This article has been cited by other articles:

				D. Berdajs, U. P. Schurr, A. Wagner, B. Seifert, M. I. Turina, and M. Genoni Incidence and pathophysiology of atrioventricular block following mitral valve replacement and ring annuloplasty. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 55 - 61. [Abstract] [Full Text] [PDF]

				N. Piazza, Y. Onuma, E. Jesserun, P. P. Kint, A.-M. Maugenest, R. H. Anderson, P. P. T. de Jaegere, and P. W. Serruys Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 310 - 316. [Abstract] [Full Text] [PDF]

				S. Dawkins, A. R. Hobson, P. R. Kalra, A. T.M. Tang, J. L. Monro, and K. D. Dawkins Permanent Pacemaker Implantation After Isolated Aortic Valve Replacement: Incidence, Indications, and Predictors Ann. Thorac. Surg., January 1, 2008; 85(1): 108 - 112. [Abstract] [Full Text] [PDF]

				D. D. Potter, T. M. Sundt III, K. J. Zehr, J. A. Dearani, R. C. Daly, C. J. Mullany, C. G.A. McGregor, F. J. Puga, H. V. Schaff, and T. A. Orszulak Operative risk of reoperative aortic valve replacement J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 94 - 103. [Abstract] [Full Text] [PDF]

				R. Hall Cased based learning on the web Heart, September 1, 2003; 89(9): 979 - 979. [Full Text] [PDF]

				R. Hall and M. Earley Learning on the Web. Case 1: syncope and palpitation in a patient following aortic valve replacement. Heart, September 1, 2003; 89(9): 979 - 979. [Full Text] [PDF]

				G Limongelli, V Ducceschi, A D'Andrea, A Renzulli, B Sarubbi, M De Feo, F Cerasuolo, R Calabro, and M Cotrufo Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience Heart, August 1, 2003; 89(8): 901 - 904. [Abstract] [Full Text] [PDF]

				B. A. Koplan, W. G. Stevenson, L. M. Epstein, S. F. Aranki, and W. H. Maisel Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery J. Am. Coll. Cardiol., March 5, 2003; 41(5): 795 - 801. [Abstract] [Full Text] [PDF]