Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and long-term mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% ± 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term.

Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality / R. Lorusso, J.M. Ravaux, F. Barili, E. Bidar, K. Vernooy, M.D. Mauro, A. Miceli, A. Parolari, A. Daprati, V. Myasoedova, F. Alamanni, C. De Vincentiis, E. Aime', F. Nicolini, G. Gonzi, A. Colli, G. Gerosa, M. De Bonis, G. Paglino, P.D. Bella, G.A. Dato, E. Varone, S. Sponga, M. Toniolo, A. Proclemer, U. Livi, G. Mariscalco, M. Cottini, C. Beghi, R. Scrofani, D. Foresti, F.P. Tritto, R. Gregorio, E. Villa, G. Troise, D. Pecora, F. Serraino, F. Jiritano, F. Rosato, E. Grasso, D. Paparella, L. Amorese, E. Vizzardi, M. Solinas, G. Arena, D. Maselli, C. Simon, M. Glauber, M. Merlo. - In: THE AMERICAN JOURNAL OF CARDIOLOGY. - ISSN 0002-9149. - 138(2021 Jan 01), pp. 66-71. [10.1016/j.amjcard.2020.10.010]

Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

Barili, Fabio;Miceli, Antonio;Parolari, Alessandro;Daprati, Andrea;Alamanni, Francesco;Foresti, Davide;Villa, Emmanuel;
2021-01-01

Abstract

Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and long-term mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% ± 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term.
Aged; Aged, 80 and over; Atrioventricular Block; Bradycardia; Coronary Artery Bypass; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Cardiac Pacing, Artificial; Cardiac Surgical Procedures; Mortality; Pacemaker, Artificial
Settore MED/23 - Chirurgia Cardiaca
13-ott-2020
Article (author)
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0002914920310766-main.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 440.27 kB
Formato Adobe PDF
440.27 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/782717
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 3
  • ???jsp.display-item.citation.isi??? 1
social impact