Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement

Kevin L. Greason, Brian D. Lahr, John M. Stulak, Yong-Mei Cha, Robert F. Rea, Hartzell V Schaff, Joseph A. Dearani

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. Methods: This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. Results: The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p < 0.001). Conclusions: Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Aortic Valve
Surgical Instruments
Mortality
Coronary Artery Bypass
Confidence Intervals
Transplants

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement. / Greason, Kevin L.; Lahr, Brian D.; Stulak, John M.; Cha, Yong-Mei; Rea, Robert F.; Schaff, Hartzell V; Dearani, Joseph A.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

@article{8413f262c3634c96b94cede5a6f38632,
title = "Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement",
abstract = "Background: The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. Methods: This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62{\%} (range, 53{\%} to 68{\%}), 3,853 patients were male (66{\%}), and coronary artery bypass graft operation was performed in 2,553 (44{\%}) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5{\%}) within 30 days of surgical aortic valve replacement. Results: The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4{\%} at 30 days, 6.4{\%} at 1 year, 23.1{\%} at 5 years, 48.3{\%} at 10 years, and 67.9{\%} at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95{\%} confidence interval, 1.20, 1.84; p < 0.001). Conclusions: Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients.",
author = "Greason, {Kevin L.} and Lahr, {Brian D.} and Stulak, {John M.} and Yong-Mei Cha and Rea, {Robert F.} and Schaff, {Hartzell V} and Dearani, {Joseph A.}",
year = "2017",
doi = "10.1016/j.athoracsur.2017.01.083",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement

AU - Greason, Kevin L.

AU - Lahr, Brian D.

AU - Stulak, John M.

AU - Cha, Yong-Mei

AU - Rea, Robert F.

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

PY - 2017

Y1 - 2017

N2 - Background: The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. Methods: This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. Results: The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p < 0.001). Conclusions: Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients.

AB - Background: The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. Methods: This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. Results: The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p < 0.001). Conclusions: Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients.

UR - http://www.scopus.com/inward/record.url?scp=85017521271&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017521271&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2017.01.083

DO - 10.1016/j.athoracsur.2017.01.083

M3 - Article

C2 - 28433222

AN - SCOPUS:85017521271

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -