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Permanent pacemaker implantation after surgical aortic valve replacement: impact in mid-term survival
Session:
Painel 5 - Arritmologia 8
Speaker:
José Máximo
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Posters
FP Number:
---
Authors:
José Máximo; Armando Abreu; Soraia Moreira; Francisca Saraiva; Rui Cerqueira; Jorge Almeida; Mário Jorge Amorim; André Lourenço; Paulo Pinho; Adelino Leite-Moreira
Abstract
<p><strong>Introduction and Aim</strong></p> <p>Rhythm disturbances are well-known complications of aortic valve replacement (AVR). New permanent pacemaker implantation (PPI) incidence is 2-6% after surgical AVR (SAVR) but over 10% following transcatheter AVR (TAVR). (Mehaffey <em>et al</em>, 2018).Our aims were to estimate the incidence and identify risk factors for PPI after SAVR with bioprosthesis, and to estimate its impact on mid-term survival.</p> <p><strong>Methods</strong></p> <p>A sub-study of Freedom Solo® versus Trifecta® single center retrospective cohort (Cerqueira <em>et al</em>, 2018) was conducted. Patients with pre-operative pacemaker and those who died during surgery were excluded from this analysis. Pre- and peri-operative data, including PPI, were collected. Median follow-up for all-cause mortality was 4.5 years. Chi-square or Fisher and independent t-tests or Mann-Whitney were used to compare categorical and continuous variables, respectively, between patients with or without need of PPI. PPI impact on cumulative survival was assessed using Kaplan-Meier estimates and log-rank test adjusted for euroSCORE II (with multivariable cox regression).</p> <p><strong>Results</strong></p> <p>938 patients were included. The incidence of PPI was 3,3% (n=31). No difference was found between genders (2.8% in males vs. 3.9% in females, p=0.368), but patients requiring PPI were older (mean age 77±6 vs. 73±9, p=0.019) and presented higher euroSCORE II (median 5.0 vs 2.7, p=0.003). None of the remaining pre and peri-operative variables were associated with PPI, namely, previous atrial fibrillation, chronic kidney disease, NYHA class, smoking, hypertension, diabetes Mellitus, cerebrovascular disease or multiple procedures. However, patients requiring PPI had longer surgeries (median cardiopulmonary bypass (CPB) time 159 vs. 116, p=0.019). 4.5-years cumulative survival was similar between patients with and without PPI (87.1% vs 82.7%, log-rank p=0.406). PPI was not associated with mortality, even after adjusting for euroSCORE II (HR: 0.59, CI95% 0.22-1.60, p=0.30). </p> <p><strong>Conclusions</strong></p> <p>Older age, higher euroSCORE II and longer CPB time increased the risk for PPI after SAVR. In our sample, new PPI after SAVR did not impact mid-term survival, which goes in line with recent TAVR <em>vs </em>SAVR literature (Fujita<em>et al</em>, 2019). The observational and retrospective design, small absolute number of PPI’s (n=31) and short follow-up are major limitations of this study.</p>
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