Risk of Pacemaker Implantation Following Aortic Root Replacement with and without Valve Preservation.
Academic Article
Overview
abstract
BACKGROUND: We compared the outcomes of aortic root replacement by composite valve grafts (CVG) and valve sparing root replacement (VSRR) operations, with an emphasis on post-operative conduction block and the need for permanent pacemaker implantation (PPM). METHODS: From 1997 to 2023, 1712 consecutive patients underwent ARR by either VSRR 501 (29%) or CVG 1211 (71%) at a high-volume aortic center. RESULTS: Patients undergoing CVG were older (59±14 vs. 49±14, p<0.001), with more cardiovascular comorbidities. Patients undergoing VSRR were more female (17% vs. 13%, p=0.042) and with more connective tissue disease (22% vs. 7.3%, p<0.001). Multivariable analysis found that the risk for PPM was higher following CVG compared to VSRR [6.5% vs. 1.2%; OR 2.83 (1.23-7.69), p=0.024]. Other variables associated with PPM include older age [OR 1.03 (1.01-1.05), p=0.006] preoperative renal impairment [OR 2.69 (1.24-5.6), p=0.010], previous operation [OR 2.76 (1.29-5.62), p=0.007], and bicuspid aortic valve [OR 3.63 (2.13-6.33), p<0.001]. Among the CVG population, patients who are at increased risk are especially those with some degree of aortic stenosis [OR 2.06 (1.18-3.61), p=0.011]. Patients who required PPM had no additive risk for long term mortality [HR 1.01 (0.47-2.17), p = 0.986], however they were more likely to have reduced ejection fraction (29.3% vs. 16%, p=0.014). CONCLUSIONS: The incidence of PPM following ARR is low, however was seen in higher rates following CVG compared to VSRR.
